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Samenvatting Algemene Heelkunde I - Ann Martens
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Een volledige samenvatting van het vak Algemene Heelkunde I. Geslaagd eerste zit.
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ALGEMENE HEELKUNDE IProf. Ann Martens
3e Bachelor Diergeneeskunde
Ugent
,Inhoud
DEEL 1 – Asepsie, chirurgisch instrumentarium en technieken ......................................................................... 6
Inleiding ........................................................................................................................................................... 6
H1 – An sep ca ............................................................................................................................................... 6
H2 – Principes van handhygiëne voor algemene DGK handelingen ................................................................... 7
H3 – Asepsie bij chirurgische ingrepen ............................................................................................................. 9
Kledij in de opera ezaal ...................................................................................................................................... 9
Pre-opera eve handhygiëne ............................................................................................................................... 9
Chirurgische scrub .......................................................................................................................................... 9
Chirurgische rub ............................................................................................................................................. 9
Aandoen van chirurgische kiel en steriele handschoenen................................................................................. 10
Voorbereiding chirurgisch veld ......................................................................................................................... 10
Afdekken chirurgisch veld ................................................................................................................................. 11
Behoud van de asepsie jdens de chirurgie ...................................................................................................... 11
H4 – Chirurgisch instrumentarium ................................................................................................................. 12
Soorten instrumenten en eigenschappen ......................................................................................................... 12
Hanteren van instrumenten .............................................................................................................................. 15
Hanteren van bistouri ................................................................................................................................... 15
Hanteren van pincet ..................................................................................................................................... 16
Hanteren van naaldhouder........................................................................................................................... 16
Hanteren van schaar ..................................................................................................................................... 16
Reinigen en steriliseren van instrumenten ........................................................................................................ 17
Reinigen ........................................................................................................................................................ 17
Steriliseren .................................................................................................................................................... 17
Stoomsterilisa e/autoclaveren (thermisch)............................................................................................. 17
Droge lucht sterilisa e (thermisch) .......................................................................................................... 18
Ethyleenoxide gas sterilisa e (chemisch) ................................................................................................. 18
Plasma gas sterilisa e (chemisch) ............................................................................................................ 19
Chemische desinfec e (chemisch) ............................................................................................................... 19
H5 – Chirurgische technieken ........................................................................................................................ 20
Elektrochirurgie ................................................................................................................................................. 20
Laser chirurgie .................................................................................................................................................. 22
Cryochirurgie..................................................................................................................................................... 23
Principes van hemostase bij chirurgie ............................................................................................................... 24
Principes van weefselirriga e bij chirurgie ....................................................................................................... 25
H6 – Hechtnaalden ........................................................................................................................................ 26
Naaldvorm ........................................................................................................................................................ 26
Naalddoorsnede................................................................................................................................................ 26
1
, Verbinding met hechtmateriaal ........................................................................................................................ 26
H7 – Hechtmateriaal....................................................................................................................................... 27
Ideaal hechtmateriaal (bestaat niet) ............................................................................................................ 27
Classifica e ....................................................................................................................................................... 27
Resorbeerbaarheid ....................................................................................................................................... 27
Structuur....................................................................................................................................................... 28
Soorten.............................................................................................................................................................. 28
Draaddikte ........................................................................................................................................................ 29
Verpakking ........................................................................................................................................................ 30
Nieuwe evolu es in het sluiten van wonden ..................................................................................................... 30
‘Barbed sutures’ ........................................................................................................................................... 30
Adhesieve strookjes/Agrafen ........................................................................................................................ 30
Agrafen voor de huid .................................................................................................................................... 30
Agrafen voor abdominale organen ............................................................................................................... 31
Kleefstoffen................................................................................................................................................... 31
H8 – Knooptechnieken ................................................................................................................................... 32
Knopen met de hand ......................................................................................................................................... 32
Knopen met de naaldhouder............................................................................................................................. 33
Molenaarsknoop ............................................................................................................................................... 33
Doorlopende hech ng + eindknoop .................................................................................................................. 33
H9 – Hechtechnieken...................................................................................................................................... 33
Eenvoudige afzonderlijke hech ng ............................................................................................................... 34
Kruishech ng ................................................................................................................................................ 34
Ver cale U-punt ........................................................................................................................................... 34
Horizontale U-punt ....................................................................................................................................... 34
Andere spanning-opvangende hech ngen................................................................................................... 34
Afzonderlijke lembert hech ng .................................................................................................................... 35
Eenvoudige doorlopende hech ng............................................................................................................... 35
Doorlopende hech ng met achterhaling ..................................................................................................... 35
Doorlopende horizontale matrasnaad (KHD) ............................................................................................... 35
Doorlopende intradermale hech ng ............................................................................................................ 35
Doorlopende lembert hech ng .................................................................................................................... 36
Cushing hech ng .......................................................................................................................................... 36
Connell hech ng ........................................................................................................................................... 36
Doorlopende inverterende hech ngen met verborgen begin – en eindknoop ........................................... 36
Beursnaad ..................................................................................................................................................... 36
H10 – Keuze hechtmateriaal en hech echniek voor weefsels......................................................................... 37
Subcu s ............................................................................................................................................................. 37
Huid................................................................................................................................................................... 37
Spieren .............................................................................................................................................................. 38
Linea alba.......................................................................................................................................................... 38
Holle organen ................................................................................................................................................... 39
2
, Bloedvaten ........................................................................................................................................................ 39
Gewrichtskapsel ................................................................................................................................................ 39
Pezen ................................................................................................................................................................. 39
DEEL 2: inflamma e, wonden, wondheling, wondverzorging (AANV) ............................................................. 40
H1 – Principes van inflamma e en trauma sche letsels ................................................................................. 40
Algemene principes van inflamma e ............................................................................................................... 40
Trauma sche letsels ......................................................................................................................................... 42
H2 – Wondheling ............................................................................................................................................ 43
Fysiologie van de wondheling ........................................................................................................................... 43
Klinische fasen van de wondheling ................................................................................................................... 47
Beïnvloeding van de wondheling ...................................................................................................................... 47
H3 – Wondverzorging ..................................................................................................................................... 48
Infec ebron ....................................................................................................................................................... 48
Risicofactoren voor wondinfec e ...................................................................................................................... 48
Aard en ernst v/d bacteriën contamina e ................................................................................................... 48
Lokale en systemische afweer v/d gastheer ................................................................................................. 49
Chirurgie-gerelateerde factoren ................................................................................................................... 50
Symptomen en diagnose van wondinfec e ...................................................................................................... 50
Behandeling van een wondinfec e ................................................................................................................... 51
Nosocomiale infec es bij de chirurgische pa ënt ............................................................................................. 51
Specifieke vormen van wondinfec e ................................................................................................................. 51
H4 – Algemene principes van wondbehandeling ............................................................................................ 54
De stappen van een wondbehandeling ............................................................................................................. 54
1. Beoordelen van de wonde ................................................................................................................... 54
2. Analgesie en anesthesie ...................................................................................................................... 54
3. Voorbereiding wondomgeving ............................................................................................................ 54
4. Spoelen van het wondbed ................................................................................................................... 54
5. Debrideren van het wondbed .............................................................................................................. 55
Chirurgisch of scherp debrideren ............................................................................................................. 55
Mechanisch debrideren ........................................................................................................................... 56
Chemisch debrideren ............................................................................................................................... 56
Enzyma sch debrideren ........................................................................................................................... 56
Autoly sch debrideren............................................................................................................................. 57
Biologisch debrideren .............................................................................................................................. 57
De beslissing tot al dan niet hechten ................................................................................................................ 57
Primaire slui ng............................................................................................................................................ 57
Uitgestelde primaire slui ng ........................................................................................................................ 57
Secundaire slui ng ....................................................................................................................................... 58
Per secundam heling .................................................................................................................................... 58
Wonddressings bij open wondbehandeling ...................................................................................................... 58
Wond dressings: indica es en gebruik ......................................................................................................... 59
3
, Absorberende wonddressings.................................................................................................................. 59
Hydrofiele wonddressings ........................................................................................................................ 59
Occlusieve synthe sche wonddressings .................................................................................................. 60
Semi-occlusieve synthe sche wonddressings .......................................................................................... 60
An microbiële wonddressings ................................................................................................................. 60
Biologische wonddressings ...................................................................................................................... 61
Topicale wondbehandeling ........................................................................................................................... 61
Drains en drainage systemen........................................................................................................................ 62
H5 – Bandages en immobilisa etechnieken bij de wondbehandeling............................................................. 66
Onderdelen van een verband ............................................................................................................................ 66
Complica es ................................................................................................................................................. 67
Verversen van een verband............................................................................................................................... 67
Specifieke bandages.......................................................................................................................................... 67
Het drukverband .......................................................................................................................................... 67
Het kleefverband .......................................................................................................................................... 67
Het stentverband.......................................................................................................................................... 67
De sling ......................................................................................................................................................... 67
Immobilisa etechnieken ................................................................................................................................... 68
Spalkverband ................................................................................................................................................ 68
Commerciële spalkverbanden.................................................................................................................. 68
Halve gipsgoot .......................................................................................................................................... 68
Dubbele gipsgoot ..................................................................................................................................... 69
Robert-Jones (spalk)verband.................................................................................................................... 69
Gipsverband ................................................................................................................................................. 69
Aanleggen van gipsverband bij KHD......................................................................................................... 70
Aanleggen van gipsverband bij paard ...................................................................................................... 70
Aanleggen van gipsverband bij kalf .......................................................................................................... 70
Aandachtpunten jdens de gipsperiode .................................................................................................. 71
Verwijderen van een gips ......................................................................................................................... 71
H6 – Principes van reconstruc eve en plas sche chirurgie ............................................................................. 72
De chirurgische techniek plannen ..................................................................................................................... 72
Basis hech ngen ............................................................................................................................................... 72
Technieken voor de opvang van wondspanning ............................................................................................... 73
Sluiten van verschillende vormen huiddefecten ................................................................................................ 76
Gesteelde huidflappen ...................................................................................................................................... 78
Vrije huidtransplanta e .................................................................................................................................... 81
H7 – Het ulcus ................................................................................................................................................ 86
De fistel ............................................................................................................................................................. 87
Hypergranula eweefsel/wild vlees ................................................................................................................... 89
Hyperkeratose ................................................................................................................................................... 89
Abormale hoornvorming ................................................................................................................................... 90
Calcifica e......................................................................................................................................................... 90
Li ekencarcinoom ............................................................................................................................................. 90
4
, Pijnlijk li eken ................................................................................................................................................... 90
Excoria es of schaafwonden ............................................................................................................................ 90
H8 – Gekneusde wonde: ecchymose en hematoom ....................................................................................... 91
Seroma en hygroma .......................................................................................................................................... 93
Drukwonde........................................................................................................................................................ 94
Steekwonde....................................................................................................................................................... 94
Snijwonde.......................................................................................................................................................... 95
Avulsie en ‘degloving’ wonde ............................................................................................................................ 95
Bijtwonde .......................................................................................................................................................... 95
Schotwonde ...................................................................................................................................................... 96
Thermische brandwonde .................................................................................................................................. 96
Chemische brandwonde.................................................................................................................................... 98
Vrieswonden/koudeletsels ................................................................................................................................ 99
Bestralingsletsels .............................................................................................................................................. 99
Wondemfyseem .............................................................................................................................................. 100
5
,DEEL 1 – Asepsie, chirurgisch instrumentarium en technieken
Inleiding
- Tijdens opera es
Werk ergonomisch, geordend en overzichtelijk
Zichtbaarheid nastreven
Stap voor stap afwerken
‘Fast surgery is good surgery’
- Nabehandeling verzorgen!
- Waarom asepsie nastreven bij chirurgische ingreep
Vermijden SSI (“surgical Site infec on”)
Oppervlakkig, diepere lagen, lichaamsholten,
tot 30d na de opera e
H1 – An sep ca
- Alcohol
Denatura e eiwi en: bactericied, ook desinfectans
Zeer krach ge en snelle werking: 60-90% meest effec eve concentra e
Licht ontve end – geen residuele werking na verdamping, daarom +
Wel: vegeta eve bacteriën/virussen + enveloppe/schimmels
Niet: virussen zonder enveloppe/sporen
- Chloorhexidine
Zout: diacetaat/digluconaat
Lage conc: lekkage celmembraan bacteriosta sch
Hoge conc: coagula e celinhoud bactericied
Wel: virusssen met enveloppe, meeste vegeta eve bacteriën
Minder/geen: sporen, schimmels, virussen zonder enveloppe, Pseudomonas, MRSA
- Jodium
Zeer ac ef tegen bacteriën, sporen, schimmels, gisten, virussen
Lage conc: penetra e celwand + denatura e EW + nucleïnezuren
Weinig resisten e door snelle werking
‘Jodoforen’ tensioac eve stof: polyvinylpyrolidine
Povidone-iodine
10% commerciële H2O oplossing
Verdunning hoofdzakelijk!
Min. 2min. contact
Geen residuele werking
Inac va e organisch materiaal
Jood nctuur: zeer irriterend!
6
, H2 – Principes van handhygiëne voor algemene DGK handelingen
- Belangrijkste maatregel voor infec econtrole
Zoöno sch
Niet-zoöno sch
- Handhygiëne: wanneer?
Voor/na pa ënt manipula e
Voor asep sche manipula es
Na contact bloed/lichaamsvocht
Tussen verzorging op 2 plaatsen lichaam
Na ui rekken handschoenen, gebruik zakdoek, telefoon, toiletbezoek
Voor eten
7
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