Introduction_To_Surgery_By_ML_Chishala.pptx

Introduction to surgery

1. Introduction to Surgery By ML CHISHALA

2. Content Definition Surgical terminologies Brief history of Surgery

3. Definition Surgery , branch of medicine that is concerned with the treatment of injuries, diseases, and other disorders by manual and instrumental means. Surgery involves the management of acute injuries and illnesses as differentiated from chronic, slowly progressing diseases, except when patients with the latter type of disease must be operated upon.

4. Surgery may be defined as “the art of treating lesions and malformations of the human body by manual operations, directly and indirectly.” The origin of the word surgery comes from the Greek word “ cheirourgikē ” ( cheir – hand, ergein – work).

5. In order to apply his/her art intelligently and successfully, it is essential that the surgeon should not only be familiar with the normal anatomy and physiology of the body and with the various pathological conditions to which it is liable, but also with the nature of the process by which repair of injured or diseased tissues is affected. Without this knowledge he is unable to recognise such deviations from the normal as result from mal–development, injury, or disease, or rationally to direct his efforts towards the correction or removal of these.

6. All forms of surgery are considered invasive procedures. Surgical procedures are commonly categorized mainly by urgency, but also by type of procedure, by body system involved, by degree of invasiveness, and by special instrumentation.
The main three categories of therapeutic surgery are described – emergency , urgent , and elective .

7. Emergency surgery , such as stopping rapid internal bleeding, is performed as soon as possible; minutes can make a difference. It must be done quickly to save life, limb, or functional capacity. Urgent surgery , such as removal of an inflamed appendix of coecum , is best performed within hours. Elective surgery , such as replacement of a hip joint, can be delayed for some period of time, until everything has been done to optimize a person‘s chances of doing well during and after the surgical procedure. It done to correct a non–life–threatening condition, and is carried out at the patient‘s request, subject to the surgeon‘s and the surgical facility‘s availability. These procedures usually treat a previously diagnosed disorder.

8. Exploratory surgery may belong to any type mentioned above; however it is performed to aid or confirm a diagnosis. A biopsy, in which a piece of tissue is removed for examination under a microscope, is the most common type of diagnostic surgery. A special type of elective surgery is aesthetic surgery . The patient feels he/she suffers from some type of appearance problem caused by congenital fault, either by the injury or postoperative deformity, or also by the aging process. The surgery is supposed to serve for the improvement of patient’s life quality, self–esteem, and social being.

9. There are other types of subdivision. There is a radical operation that removes the cause of problem (e.g., removal of appendix of caecum = appendectomia ), and palliative one, which only facilitates following life or the treatment, but leaves the reason (for example it leaves out of the section of digestive tract, where is a continuity failure due to unremovable tumour , the surgery connects segment above and below tumour = gastrojejunoanastomosis instead of that).

10. Operations can be also divided according to indications . Vital indication means that patient definitely dies without a surgery. Absolute indication represents an ideal solution, while a relative indication is one of the treatment options. It is also possible to talk about contraindications , which relate to the severity of the disease and the condition of the patient as well as to the cost and burden of operation in correlation with benefit of surgery for the patient. The term absolute and relative contraindications, however, lose the unique meaning in process of time.

11. Surgical Terminologies Incision means opening of the surgical wound, verbatim cut. Excision means cutting out an organ, tumour , or other tissue. Surgery terms often start with a name for the organ being excised (cut out) and the suffix – ectomy is added (for example mastectomy). Extirpation is complete removal of pathological lesion, which is clearly defined

12. 4. Resection is partial removal of an organ or other bodily structure. 5. Amputation involves cutting off a body part, for example a limb or a digit.
6. Procedures, which involve cutting into an organ or tissue , end by suffix – otomy . For example a surgical procedure cutting through the abdominal wall to gain access to the abdominal cavity is called laparotomy.
7. Procedures for formation of an opening called a stoma in the body have suffix – ostomy .
The stoma is a permanent or temporary opening of tube organ (like stomach or urinary bladder), which is situated at the surface of the body.

13. 9. The surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis . 10. Replantation involves reattaching a severed body part (for example finger) 11. Transplantation means transfer of the harvested tissue or organ from the donor site to
the recipient area.

14. 12. It can come from the individual and be used to the same one ( autogenous ), or harvested from the genetically different individual and used to the other of the same species ( allogenous ). 13. The transfer is rare between genetically identical individuals – uniovular twins (called isogenic ). Xenogenous transplantation is the term used for transfer between the individuals of the different species. 14. The tissue may be simply inserted (blood transfusion), used as a graft (skin, bone), or it is reconnected to the recipient in all necessary ways for supply and function like blood vessels, ducts, etc. (for example kidney).

15. 15. Prosthetics are artificial substitutes, which is used for repair or for replacement of particular part of the body or tissue. They may also serve as an anchor for specific devices. For example pins or screws may be used to set and hold bone fragments. Sections of bone may be replaced with prosthetic rods or plates

16. Artificial hip replacement has become more common.
Heart pacemakers or valves may be inserted. Some prosthetics just increase the quality of the patient´s life
and substitute the missed external shape of the body; they are called epithesis (for example nasal or mammary epithesis ).

17. • Adhesions : scar-like tissue inside the body that bind surfaces together
• Fistula : an abnormal connection between two epithelial surfaces
• Tenesmus : the sensation of needing to open bowels without being able to produce stools (often accompanied by pain)

18. Prefixes Prefixes generally refer to an area of the body: • Laparo - refers to the abdomen (e.g., laparotomy – open surgery on the abdomen)
• Thoraco - refers to the chest (e.g., thoracotomy – open surgery on the chest)
• Colo - refers to the colon (e.g., colectomy – removal of the colon)
• Cysto - refers to the bladder (e.g., cystoscopy – putting a endoscopic camera into the
bladder)
• Gastro- refers to the stomach (e.g., gastroscopy – putting a endoscopic camera into the stomach)
• Mammo - refers to the breast (e.g., mammogram – imaging of the breast)
• Masto - refers to the breast (e.g., mastectomy – removal of the breast)

19. • Myo - refers to muscle tissue (e.g., myotomy – where the muscle tissue is cut open)
• Nephro - refers to the kidneys (e.g., nephrectomy – removal of a kidney)
• Pneumo - refers to the lungs (e.g., pneumonectomy – removal of a lung)
• Orchid- refers to the testes (e.g., orchidectomy – removal of a testicle)
• Rhino- refers to nose (e.g., rhinoplasty – changing the shape of the nose)
• Lobo- refers to a lobe of an organ (e.g., lobectomy – removal of a lobe of the lung)

20. Suffixes Suffixes generally refer to what is happening with a particular area of the body: • - otomy refers to surgically cutting open (e.g., laparotomy – open surgery on the abdomen)
• - oscopy refers to viewing with a scope and keyhole surgery (e.g., colonoscopy, laparoscopy and thoracoscopy )
• - ectomy refers to removal (e.g., tonsillectomy – removal of the tonsils)
• - plasty refers to changing the shape (e.g., rhinoplasty – changing the shape of the nose)
• - pexy refers to fixing something in place (e.g., orchidopexy – surgery to fix a testicle in the correct place)

21. - centesis refers to puncturing with a needle (e.g., thoracocentesis – removing air or fluid from the pleural space)
• -ostomy refers to creating a new opening (e.g., colostomy – opening the colon onto the surface of the abdomen)
• - itis refers to inflammation (e.g., prostatitis – inflammation of the prostate)
• - algia refers to pain (e.g., mastalgia – breast pain)
• - gram refers to recording or imaging (e.g., electrocardiogram or echocardiogram)

22. Surgery is used for a great variety of diseases and involves many different surgical techniques.
But there are still four fundamental steps inevitable for every surgeon and his/her patient, considering any operation:
1. Analysis (patient s condition, options, risks, complications) 2. Preparing for surgery
3. Performing the operation 4. Healing and recovery

23. Basic rule of Surgery: Every surgery must be indicated according to the particular l individual , his/her health condition, need and expectations, and at last but not the least according to facility possibilities and surgeon’s skill.

24. History Surgery is as old as humanity, for anyone who has ever stanched a wound has acted as a surgeon. In some ancient civilizations surgery reached a rather high level of development, as in India, China, Egypt, and Hellenistic Greece. In the 18 th century, with increasing knowledge of anatomy, such operative procedures as amputations of the extremities, excision of tumours on the surface of the body, and removal of stones from the urinary bladder had helped to firmly establish surgery in the medical curriculum. Accurate anatomical knowledge enabled surgeons to operate more rapidly;

25. Patients were sedated with opium or made drunk with alcohol, tied down, and a leg amputation, for example, could then be done in three to five minutes. The pain involved in such procedures, however, continued to limit expansion of the field until the introduction of ether anesthesia in 1846. The number of operations thereafter increased markedly, but only to accentuate the frequency and severity of “surgical infections.”

26. In the mid-19 th century the French microbiologist Louis Pasteur developed an understanding of the relationship of bacteria to infectious diseases, and the application of this theory to wound sepsis by the British surgeon Joseph Lister from 1867 resulted in the technique of antisepsis, which brought about a remarkable reduction in the mortality rate from wound infections after operations. The twin emergence of anesthesia and antisepsis marked the beginning of modern surgery.