성인간호학실습 수술실 케이스

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1. Acute calculous cholecystitis, with adenomyomatosis

Acute calculous cholecystitis는 GB stone 등으로 인해 cystic duct가 좁아지면서 GB 내부에 염증이 발생한 질환입니다. 주요 증상으로는 RUQ 통증, fever, nausea, vomiting 등이 있으며, 복부 초음파 검사나 GB 동위원소 촬영으로 진단할 수 있습니다. 치료는 금식, 수액 공급, 약물 투여 등의 보존적 치료와 함께 cholecystectomy 수술이 필요합니다.
2. Umbilical hernia

Umbilical hernia는 Umbilicus 부위에 발생하는 hernia로, intestine이나 peritoneum의 일부가 Umbilicus의 피부층을 밀고 나온 질환입니다. 주로 신생아에게 많이 발생하지만, 성인에서도 pregnancy, liver cirrhosis, obesity 등의 요인으로 발생할 수 있습니다. 증상으로는 Umbilicus가 볼록하게 튀어나오는 것이 특징이며, 수술적 치료가 필요합니다.
3. Laparoscopic cholecystectomy

Laparoscopic cholecystectomy는 복강경을 이용하여 담낭을 절제하는 수술입니다. 복부에 작은 절개창을 내고 CO2 gas를 주입하여 수술 및 시야를 확보한 뒤, 3개의 구멍을 통해 수술을 진행합니다. Open surgery에 비해 창상 통증이 적고 회복이 빠른 장점이 있어, 증상이 있는 GB stone, GB polyp, 만성 용혈성 질환 등의 경우 시행할 수 있습니다.
4. Umbilical hernia repair

Umbilical hernia 수술은 Umbilicus 아래 부분을 작게 절개하여 내용물을 peritoneum 내로 위치시킨 뒤 봉합하는 방식으로 진행됩니다. Hernia 부위가 점점 커지거나 통증이 있는 경우 합병증 예방을 위해 수술적 치료가 필요합니다.

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1. Acute calculous cholecystitis, with adenomyomatosis

Acute calculous cholecystitis with adenomyomatosis is a complex condition that requires careful evaluation and management. Adenomyomatosis is a hyperplastic condition of the gallbladder wall, which can lead to thickening and the formation of intramural diverticula. This can complicate the presentation of acute cholecystitis, making diagnosis and treatment more challenging. Prompt recognition and appropriate treatment are crucial to prevent complications such as perforation, empyema, or gangrene. Conservative management with antibiotics and supportive care may be appropriate in some cases, but surgical intervention is often necessary, particularly in the setting of acute inflammation or complications. Laparoscopic cholecystectomy remains the gold standard treatment, but the presence of adenomyomatosis may increase the technical difficulty and risk of the procedure. Careful preoperative planning, meticulous surgical technique, and a low threshold for conversion to open surgery are important considerations. Overall, a multidisciplinary approach involving gastroenterologists, radiologists, and experienced hepatobiliary surgeons is essential for optimal management of this complex condition.
2. Umbilical hernia

Umbilical hernias are a common condition, particularly in infants and young children, but they can also occur in adults. They are characterized by the protrusion of abdominal contents, such as fat or intestine, through a defect in the abdominal wall at the umbilicus. While many umbilical hernias in children may resolve spontaneously, larger or symptomatic hernias, as well as those in adults, often require surgical repair. The goals of umbilical hernia repair are to close the defect in the abdominal wall, restore normal anatomy, and prevent recurrence. Surgical techniques may involve primary suture repair or the use of mesh reinforcement, depending on the size and complexity of the defect. Laparoscopic approaches have become increasingly common, offering the potential benefits of reduced postoperative pain, faster recovery, and improved cosmetic outcomes. However, the choice of surgical technique should be tailored to the individual patient's anatomy and risk factors. Careful patient selection, meticulous surgical technique, and appropriate postoperative management are essential for achieving successful outcomes in the treatment of umbilical hernias.
3. Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallbladder disease, including cholelithiasis and cholecystitis. This minimally invasive surgical approach offers numerous advantages over open cholecystectomy, including reduced postoperative pain, shorter hospital stays, faster recovery, and improved cosmetic outcomes. The laparoscopic technique involves the removal of the gallbladder through small incisions in the abdomen, using specialized instruments and a camera (laparoscope) to guide the procedure. Careful patient selection, meticulous surgical technique, and a thorough understanding of the anatomy are crucial for the successful and safe performance of laparoscopic cholecystectomy. Potential complications, such as bile duct injury, bleeding, and infection, must be recognized and managed promptly. Ongoing advancements in surgical technology, including the use of robotic-assisted platforms, have further refined the laparoscopic approach and may offer additional benefits in selected cases. Overall, laparoscopic cholecystectomy has become the standard of care for the majority of patients with gallbladder disease, providing excellent outcomes when performed by experienced surgeons.
4. Umbilical hernia repair

Umbilical hernia repair is a common surgical procedure performed to address a defect in the abdominal wall at the umbilicus, which allows for the protrusion of abdominal contents. The primary goals of umbilical hernia repair are to close the defect, restore normal anatomy, and prevent recurrence. Both open and laparoscopic techniques are utilized, with the choice of approach depending on factors such as the size and complexity of the hernia, the patient's anatomy, and the surgeon's experience. Open repair may involve primary suture closure or the use of mesh reinforcement, while laparoscopic techniques often employ the placement of a mesh prosthetic to strengthen the abdominal wall. Careful patient selection, meticulous surgical technique, and appropriate postoperative management are essential for achieving successful outcomes and minimizing the risk of complications, such as wound infection, seroma formation, and hernia recurrence. Ongoing research and advancements in surgical technology, including the use of minimally invasive approaches and novel mesh materials, continue to improve the outcomes of umbilical hernia repair. Overall, umbilical hernia repair is a common and generally safe procedure when performed by experienced surgeons, providing patients with effective treatment and a low risk of recurrence.

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