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Types of needles
Curved needles 5/8 of circle 1/2 of circle3/8 of circle
Types of needles according to the threading Eyed Eyeless
Types of needles according to cut section Cutting needleRounded needle
Control of 1ry hemorrhage
1ry hemorrhage Place pack for 4 min
Hold the injured vessels by 2 artery forceps
Artery :high pressureVein :low pressure 3 ligations 2 ligations
Types of sutures
Tension suture On tension of the suture It takes muscles &peritoneum
Position of the patient in the chest drain
Mid axillary line Ant. Axillary line Sit of the incision
Ant. axillary lineMed. axillary line Points of drain
Spread the muscle fibers by artery forceps to expose pleura Lung
Pierce pleura and introduce finger to confirm entry to pleura
Guiding of the drain by your finger
Make sure that the incision is large enough to accommodate the drain + your finger Drain
Suture the drain with loss sutures to the skin Drain
Normal spleen anatomy
Stomach Ant.lienorenal lig Pancreas Kidney Post.lienorenal lig. Spleen Gastrosplenic lig.
Pancreas Anterior lienorenal ligament posterior lienorenal ligament Gastro pherenic ligament Spleen
Gastropherenic ligament Ant. layer of lienorenal ligament Post. Layer of lienorenal ligament
Down displacement of the stomach
Insertion of hot packs behind spleen
Hot packs around spleen
Stomach (medially) Spleen (medially) Divide the posterior layer of lienorenal ligament Hot packs
Traction of the spleen medially Divide the posterior layer of lienorenal ligament
Divide the gastrosplenic ligament
Divide the anterior layer of the lienorenal ligament
Pancreas Splenic artery Pos. lienorenal lig. Spleen Ant. Lienorenal lig.
Divide splenic vein Squeeze the spleen
Multiple splenic adhesions
Rectum and anal canal
Overall view of the rectum and anal canal Rectum Anal canal
Rectum External sph.Internal sph. Anal canal Anatomy of rectum and anal canal Dentate line
Superior rectal vein External anal sphincter Internal anal sphincter Anal canal Internal plexus of veins Anatomical anal canal structure
External opening of the fistula The track of the fistula Internal opening of the fistula
Insertion of probe Probe
Rode of glass Insertion of rode of glass in the fistula
Opining of the fistula by cut the skin on the glass rode along the all track
Anus The external opining of the fistula The triangular track of the incision
The healing by Granulation tissue
Anal fissure (lower part of anal canal)
Anal fissure Sentinel pile Traction of the fissure from sentinel pile
Removal of the fissure+ the skin around it Internal sphincter
Fissuerectom and posterior internal sphincterectomy Internal sphincter
External sphincter Superior rectal vein Plexus of veins (site of internal piles Internal sphincter
Internal piles Superior rectal vein
Hold the piles by 2 Allis forceps
Sit of the V- incision in the anal skin
Ligation of the root of the piles Part of anal skin
V- shape incision in the skin
The pile V shape incision
Sits of primary piles
Healthy skin Granulation tissue
Retract the propuce backwards Clean the coronal sulcus by alcohol
Ring anesthesia at the base of the penis
Traction of the propuce by artery forceps
Squeeze pines glandes
Bone cutting method circumcision Bone cutting forceps
Cut the prepuce till sulcus of glans penis Artery forceps
Cut the propuce all around the coronal sulcus
Mucous membrane of the penis Interrupted sutures
Anterior superior iliac spine Incision Ribs Incision for renal operations
Site of incision Per renal fat Serretus post. Ltissmus dorsi Fascia trans. Tranversus abd. Internal obiq. External obliq. Kidney Peritoneum
Latissmus dorsi External oblique Incision
External obliq. Latissmus dorsi Serretus posterior Internal obliq.
Fascia Transversalis External obliq. Latissmus dorsi Serretus posterior Internal obliq.
Transverses abdominus Lumber fascia
kidney Peritoneum Pre renal fat Move the pre renal fat by finger
Separation of the peri renal fat to separate kidney from supra renal gland
If we don't separate the ft we remove the supra renal gland with kidney
Ureter (posterior) Renal artery (middle ) Renal vein (anterior) Identify the ureter
Ligate and divide the ureter as low as possible
Brodel's bloodless line incision Nephrolithetomy
Nephrolithetomy Radial incision
Ligation above &below the stone in the ureter
Removal of the stone
Stone in the urinary bladder
Site of incision
Removal of the stone
Subcutaneous (C), superficial (B), deep (A) The rectum and anal canal are supplied by the superior rectal artery (the continuation of the inferior.
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