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Related Concept Videos

Peritoneum01:21

Peritoneum

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The peritoneum is a vital membrane that lines the abdominal cavity and covers most of the organs within it. It plays a crucial role in protecting the organs, providing a smooth surface for their movement, and facilitating various physiological processes. Understanding the anatomy and function of the peritoneum is essential for comprehending the complexities of the abdominal region.
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Appendicitis-I: Introduction01:22

Appendicitis-I: Introduction

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The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
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Assessment of the Abdomen III: Palpation01:23

Assessment of the Abdomen III: Palpation

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Palpation is a crucial tactile examination method for assessing abdominal organs and detecting conditions like tenderness, distention, masses, or fluid. It involves both light and deep palpation techniques, each serving specific diagnostic purposes. Light palpation helps identify tenderness and other surface-level indicators, while deep palpation locates and assess abdominal masses and organ boundaries. A skilled professional can gather valuable insights through palpation, including evaluating...
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Assessment of the Abdomen II: Percussion01:18

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Percussion is a fundamental technique used to assess the liver, spleen, and abdominal organs by tapping the abdomen and interpreting the resulting sounds. This method helps identify fluid, distention, and masses through variations in sound, such as the high-pitched tympany of air-filled areas and the dullness of solid masses. Understanding how to percuss these organs provides valuable information for healthcare professionals in diagnosing conditions early.
Percussion
Percussion is an essential...
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Acute Pancreatitis I: Introduction01:27

Acute Pancreatitis I: Introduction

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Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. It can be either acute or chronic.
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
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Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

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Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
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Open abdomen and VAC® in severe diffuse peritonitis.

Ventsislav M Mutafchiyski1, G I Popivanov2, K T Kjossev3

  • 1Department of Military Surgery, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy, Sofia, Bulgaria.

Journal of the Royal Army Medical Corps
|February 26, 2015
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Summary

Vacuum-assisted closure (VAC) significantly improves outcomes for patients with severe diffuse peritonitis and open abdomens, leading to better fascial closure and reduced mortality. This technique enhances recovery compared to traditional methods without negative pressure.

Keywords:
SURGERYWOUND MANAGEMENT

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Area of Science:

  • Abdominal Surgery
  • Critical Care Medicine
  • Wound Healing

Background:

  • The open abdomen technique is standard for severe intra-abdominal conditions.
  • Negative pressure wound therapy (NPWT) shows promise, but results in diffuse peritonitis are mixed.

Purpose of the Study:

  • To compare vacuum-assisted closure (VAC) with standard mesh-foil laparostomy for open abdomens in diffuse peritonitis.
  • To evaluate the impact on fascial closure rates, mortality, and complications.

Main Methods:

  • Prospective enrollment of 108 patients with diffuse peritonitis and open abdomen.
  • Comparison between 69 patients treated with mesh-foil laparostomy and 49 with VAC.
  • Primary endpoints: primary fascial closure rate and mortality; secondary: complication rates and hospital stay.

Main Results:

  • VAC demonstrated higher overall (73% vs. 53%) and late primary fascial closure rates (31% vs. 7%).
  • VAC significantly reduced necrotizing fasciitis (2% vs. 15%), intra-abdominal abscesses (10% vs. 20%), enteroatmospheric fistulas (8% vs. 19%), and overall mortality (31% vs. 53%).
  • Patients treated with VAC experienced shorter ICU (6.1 vs. 10.6 days) and hospital stays (15.1 vs. 25.9 days).

Conclusions:

  • VAC offers a significant advantage over non-negative pressure methods for severe diffuse peritonitis.
  • The combination of VAC with dynamic fascial closure may contribute to improved outcomes.