Having dressed an intestine in this

Having dressed an intestine in this place two ligatures, a cross-section dissect an intestine between ligatures. Now, strongly having grasped fingers of the left arm the jejunum beginning, separate its knife from bry-zhejki, all time delaying an intestine to itself. To medrol separate an intestine from a mesentery it is necessary long a knife, holding it for the handle, as a bow, its plane perpendicularly to an intestine, Doing thus, as a bow, wide free a knife to the right and to the left to cut all edge, Instead of its part, and not rendering thus any having given .,--. When the jejunum, will be separated on distance of the lifted left arm, it better accurately to put on a neck of a corpse then not to lose its beginning and not to spend time for searches. The left arm grasp a new loop at the mesentery where the cut has stopped, and continue in its same way, separating and an ileal intestine '. Length of a jejunum approximately 2,5 m, and ileal - 3,5. 104 Now separated loops of intestines stack directly on a dissecting table to the right of a corpse, i.e. About itself. For this purpose it is necessary to take place, that the intestine and its contents casually have not polluted a floor and feet of the prosector. Therefore we recommend a corpse to stack not on the table middle, and a little bit further, from ourselves, leaving to the right of a corpse on a table there is more than place, than at the left. Having reached a place of a confluence of an ileal intestine in blind, start unit of colons.
For this purpose, having rejected a caecum to the left, dissect a knife a peritoneum on the right side of its and ascending colonic, and - fields to the right, separate a part a knife, a part stupid by from a back wall of an abdominal cavity. Having reached so to the right flexure of a colon, delay "it in a caudal direction and dissect ligament intestines with a stomach (lig. gastro-colicum) and its mesentery (mesocolon transversum). Continuing to delay the left arm in the same direction the subsequent parts of a colon, approach to its left flexure, a descending colonic intestine and sigmoid. Separate last from its mesentery and reach a rectum. Here, in the heart of a basin, dress an intestine two ligatures and between them dissect it. All intestines lay now on the middle of a table to the right of a corpse, and their beginning - on a neck of a corpse. So usually take an intestine. If there are indicatings on the pathological processes proceeding simultaneously in an intestine and in a mesentery in that case it is better to take an intestine together with a mesentery. For this purpose at first allocate colons, since blind as it is already described, not separating it from the ileal. After otde - a sigmoid intestine from a straight line postpone colons in the right party of a corpse, and small bowels allocate together with a mesentery, having cut off it. places ' attachments to a backbone. If there are fistulous reports, strong solderings or enteroanastomoses they should buy tramadol ultram not be separated, and it is necessary to take separately, preliminary having dressed loops of intestines ligatures. In the same way arrive and at an adnation of intestines with - a liver, a stomach, a cholic bubble, with the loop of a small bowel filed to a stomach at operation of a gastroenterostomy, fecal fistulas etc. . 105 In detection cases about m about and vessels of a mesentery the unit of intestines is better to suspend and take an intestine together with a mesentery and an aorta at a clottage of arteries or together with a portal vein, a liver, a stomach, a duodenum, a pancreas and a lien at a vein thrombosis. LIEN EXTRACTION Lien extraction make usually separately From other organs. For this purpose the right arm reject In the right party of a corpse a greater cul-de-sac, and the left arm for a lien also delay it to itself; thus It is possible to examine hiluses lienis, vessels and its ligaments - lig. gastro-lienale and lig. phreni, ligaments dissect a knife, And the separated lien stack on a table to the left of Corpse., In cases when there are strong adnations of a lien with a stomach or a pancreas, at wounds, a clottage of its vessels or at germination by a tumour, the lien needs to be taken not separately, and together with a stomach, a liver and others 1. LIVER AND STOMACH EXTRACTION WITH THE DUODENUM, PANCREAS AND MESENTERY These organs take all together in the form of one . First of all dissect a diaphragm. For this purpose the left arm reject a liver in a left-hand side of a corpse, paternal right . stretches. Thus it is convenient enough for cutting from ribs usual movement 1 In the press to us the reproach concerning separate extraction of a lien as the integrity of portal system of a circulation is thus broken is made. This reproach quite lawfully can be carried and to an intestine. However hardly probable there is a necessity to take every time all , that considerably complicates opening. If for joint extraction of a liver, a stomach, a duodenum, a pancreas, a mesentery, a lien and an intestine there are indications it us is recommended both in the first, and in the second edition of the book both for a lien, and for an intestine. About it also it is spoken and in introduction (p. 8) and. p. 114 given editions. 106 Amputating knife from left to right. Having reached a right kidney and continuing to reject a liver further, it is cautious the right adrenal from a liver under the control of eyes. - Then cross in a cross-section direction the bottom vena cava, leaving its part which has been-bound to a liver; with a liver separate also a vertical part of a duodenum with a pancreas head. After that a liver return in former position. Now, having grasped the left arm the left part of a diaphragm and delaying it to itself, cut it from ribs. Further, removing the left arm in the right party of a corpse a stomach and having grasped fingers a pancreas tail, from the left adrenal and a back abdominal wall under the control of eyes.