Name: Current diagnosis and treatment
Author: Alan H. Decherney
Publication: Mc-graw Hill Education
Category: Medical Books
Size: 63.2 MB
Format: E-Book (PDF)
Total Pages: 1982
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Summary : Current diagnosis and treatment
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contain edherein with other sources.
2 Summary : Current diagnosis and treatment
For example and in particular, readers are advised to check the produc tinformation sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in there commended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work,you may not de compile, disassemble.
3 Summary : Current diagnosis and treatment
The abdominal skin is smooth, fine, and very elastic. It is loosely attached to underlying structuresexcept at the umbilicus, where it is firmly adherent. Langer’s lines are lines of tension based on theorientation of dermal fibers in the skin. On the anterior abdominal wall, these lines are arrangedmostly in a transverse fashion. As a consequence, vertical incisions heal under more tension andtherefore have a propensity to develop into wider scars. This is more noticeable in those patientswho tend to form keloids. Conversely, transverse incisions, like a Pfannenstiel, heal with a muchbetter cosmetic appearance.
4 Summary: Current diagnosis and treatment
The inferior epigastric artery, a branch of the external iliac artery, usually arises just above theinguinal ligament and passes on the medial side of the round ligament to the abdominal inguinal ring.From there, it ascends in a slightly medial direction, passing above and lateral to the subcutaneousinguinal ring, which lies between the fascia transversalis and the peritoneum. Piercing the fasciatransversalis, it passes in front of the linea semicircularis, turns upward between the rectus and itssheath, enters the substance of the rectus muscle, and meets the superior epigastric artery. Thesuperior epigastric supplies the upper central abdominal wall, the inferior supplies the lower centralpart of the anterior abdominal wall, and the deep circumflex supplies the lower lateral part of the abdominal wall.
5 Summary: Current diagnosis and treatment
The deep circumflex iliac artery is also a branch of the external iliac artery, arising from its sideeither opposite the epigastric artery or slightly below the origin of that vessel. It courses laterallybehind the inguinal ligament lying between the fascia transversal is and the peritoneum. The deepcircumflex artery perforates the transversus near the anterior superior spine of the ilium and continues between the transversus and internal oblique along and slightly above the crest of the ilium, finally running poster iorly to an astomose with the iliolumbar artery. A branch of the deep circumflex iliacartery is important to the surgeon because it forms an astomoses with branches of the in feriore pigastric.
The various incisions on the abdomen encounter some muscle planes and vasculature of clinicalsignificance. The McBurney incision requires separation of the external and internal oblique musclesand splitting of the transversus. The deep circumflex artery may be frequently encountered. Theparamedian incision is made in the right or left rectus. Below the arcuate line, the fascia of theexternal and internal oblique, as well as the transversus muscles when present, goes over the rectusabdominis; above the arcuate line, the transversus and part of the internal oblique go under the rectus.The vasculature is primarily perforators and frequently the thoracoabdominal vein. Inferiorly, thesuperficial epigastric may be encountered.
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