Examine a mesentery of a cross-section

Examine a mesentery of a cross-section colonic intestine and feel through its root a pancreas. Examine intestines, not tampering with them, and note position, an inflation or fall of their departments. Then, having removed loops of small bowels from a blind corpse in a left-hand side, examine a caecum and its process. Then examine all colon to a straight line. After that, buy ultram tramadol cautiously moving apart loops of intestines, note their interposition, further choose intestines from an abdominal cavity to itself, in the right party of a corpse, examine a mesentery notice its thickness that depends on larger or smaller quantity of Adeps, lymph nodes, a condition of vascular and lactiferous vessels. If the last are dilated and look like narrow strias, it is necessary to investigate the lactiferous tank (cister-na chyli) and a thoracal duct. Further examine organs of a small basin, them Position, bladder size, and at women - on a uterus and its appendages and their relation to the neighbour It to organs and to a peritoneum. ' Then feel kidneys and find out their position and degree of mobility and, at last, as far as possible, examine a back wall of an abdominal cavity. If there are operational cuts or stomach wounds, carefully examine the channel, not concerning it, and then cautiously separate the organs, all time under the strict control of eyes, Only now it is possible to make the necessary cuts.
Having entered a finger in an epiploon pocket (bursa omentalis) che-rez foramen epipiocum Winslowi, it is possible to open a portal vein a hepatic artery and the general cholic duct, not damaging ; open an epiploon pocket, cut mesentery lymph nodes, part adnations, mesentery vessels, open them and investigate on presence of thrombuses and so forth At a strong gastrectasia A.I.Abrikosov recommends to look, whether the duodenum to a backbone by the tense mesentery of small bowels and the top mesenteric artery, , is pressed. Whether is not present arterio-mezenterialnogo duodenum closing. Having finished survey and research of an abdominal cavity, note a condition of a visceral peritoneum at which on a research course all time it is necessary to look narrowly (colour, vessels, a hemorrhage, dimness or a transparency, humidity or dryness, a roughness from applyings of fibrin, pus and so forth). At last, note quantity and character of a liquid in brjush - Ache cavities, its colour, a transparency or , a consistence, a smell, an impurity of a feces, nutrition, gas and so forth If in an abdominal cavity the feces, nutrition, ascarides and so forth it is necessary to find a place of a perforation of the stomach or intestines before extraction of organs, carefully looking through a stomach, an intestine, an appendix are found out. Can meet and exsudates; in these cases for soldering research it is necessary to dissect. THORAX OPENING After survey of a cavity of a stomach start thorax opening. However before to open a thorax, it once again examine, already bared, and note the form, size, symmetry and asymmetry; then note the breast bone form (for example, a "chicken" breast and so forth) and its relation to ribs, junctions of ribs with cartilages, places of operations and so forth For pulmonary collapse prevention it is necessary to dress a trachea before thorax opening to have possibility to judge a lung expansion buy pyridium online and atelectases. The last can arise and be lethal after a narcosis and after operations on heart and on lungs. Now, taking in a fist a costochondral knife (fig. 32) and holding it it is horizontal, put its cutting edge on a cartilage of II rib. An eye plan a line of its movement which should pass on cartilages of all ribs from II to X, for 0,5 sm from a junction of cartilages with ribs. For development of larger force by a palm of the left arm press a knife to a cartilage of II rib. Now one movement of arms to the right dissect all costal cartilages on the planned line. This operation make at first on the right, and then and at the left. To work it is necessary resolutely and confidently, but it is cautious not to damage organs. It is easier for observing, giving to a knife blade the position parallel to a surface of a thorax, cutting all cutting party and doing fast movement. Last circumstance provides fast hit of a knife on the following costal cartilage and prevents it in depth. 90 If there is no costochondral knife this operation can be made and a small post-mortem knife, observing the same conditions. Together with crossing of cartilages dissect intercostal muscles and a pleura. Having grasped a breast bone fingers of the left arm at a xiphoid process, it raise also a post-mortem knife cut from it a diaphragm and mediastinal th fat a little, holding a knife all time as is possible more close to costal cartilages and a breast bone not to wound organs and not to open a warm shirt. Fig. 32 Costochondral knife. Now, taking a post-mortem knife in a fist for the handle and holding it upright an edge upwards and an edge from itself forward and having raised the left arm a breast bone, simultaneously take away it in a left-hand side of a corpse, enter a fist into the Thoracal cavity under a breast bone so that the knife blade came out through the right cut of cartilages. Having referred an edge obliquely outside, to the left from itself, dissect a cartilage of I rib on the right and further, without efforts turning an edge inside, to the right from itself, to a median line, then forward, to a head, easily make a section of grudino-kljuchich th joint with right, and then and on the left side. At correct movements it is possible easily and vessels thus will not be wounded.