Veidlapa Nr. M-3 (8)
Study Course Description
Surgical Diseases II
Course Code
KK_014
Branch of Science
Clinical medicine; Surgery
ECTS
4.50
Target Audience
Medicine
LQF
Level 7
Study Type And Form
Full-Time
Study Course Implementer
Course Supervisor
Kaspars Zeiza
Structure Unit Manager
Jānis Gardovskis
Structural Unit
Department of Surgery
Contacts
Riga, 13 Pilsonu Street, VSIA P.Stradiņa KUS, Block No 24, kk@rsu.lv, +371 67069745
About Study Course
Objective
To acquire knowledge of urgent and elective abdominal and vascular surgical diseases their aetiology, pathogenesis, clinical picture, diagnostics, principles of surgical and medical treatment and prevention.
Preliminary Knowledge
Anatomy, physiology and pathology of the corresponding anatomic region, basics of propaedeutics
Learning Outcomes
Knowledge
1.On successful completion of the course, the students will be able to: • list and describe urgent and elective abdominal and vascular surgical diseases, their aetiology and pathogenesis; • explain the clinical picture, diagnostics, principles of treatment and prevention of urgent and elective abdominal and vascular surgical diseases; • describe up-to-date methods of clinical, laboratory and instrumental investigation; • discuss surgical treatment methods and their indications.
Skills
1.As a result of successful completion of the course, the students will be able to: • perform physical examination of a patient using palpation, percussion and auscultation; • explain the results of upper G-I tract endoscopy; • perform investigation of the vascular system and explain treatment possibilities of vascular diseases; • perform medical care of the stoma patient.
Competences
1.On successful completion of the course, the students will be able to: • analyse data of patient examination; • prepare necessary laboratory and instrumental investigation plan for the patient; • analyse a surgical case and interpret data acquired from laboratory and instrumental investigation methods; • formulate and justify a full clinical diagnosis; • plan tactics for a surgical clinical case; • formulate indications for surgical and conservative treatment.
Assessment
Individual work
|
Title
|
% from total grade
|
Grade
|
|---|---|---|
|
1.
Individual work |
-
|
-
|
|
1) MCQ self-control tests must be completed before every class in E-studies.
2) Student writes a clinical case history (if available due to restrictions in hospitals).
3) General surgery: after the general surgery cycle student completes a clinical case report task in E-studies.
4) Vascular surgery: during the third class of vascular surgery student presents an independently completed task, described, and given by the teacher during the classes.
|
||
Examination
|
Title
|
% from total grade
|
Grade
|
|---|---|---|
|
1.
Examination |
-
|
-
|
|
Control of the theoretical knowledge of the material learned is carried out throughout the practical classes as well as discussion of clinical cases by which the students’ knowledge of aetiology, pathogenesis, clinical picture, diagnostics, treatment principles and prevention of surgical diseases is assessed.
Final evaluation (grade) in this study course is calculated from two marks of equal importance:
1) Assessment of student’s activity during the course – 50%. This mark includes evaluation of the clinical case report (20%), result of the general surgery case report task completed after the cycle (20%) and evaluation of student’s activity during the vascular surgery classes (10%).
2) Exam mark – 50%. Exam is computer-based test which consists of two parts and is organized for all student groups at once. 1st part: MCQ test with 100 questions (25% of the final grade), 2nd part: 2 clinical case report tasks (25% of the final grade).
(Exam can be subject to a change, in which case detailed information will be available in E-studies)
|
||
Study Course Theme Plan
FULL-TIME
Part 1
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Auditorium
|
2
|
Topics
|
Peripheral Arterial Disease (PAD). Algorithm for Diagnosis of PAD. Basic Concepts in Vascular Surgery. Treatment of PAD. Management of intermittent claudication. Management of chronic limb-threatening ischaemia. Acute limb ischemia. Management of acute limb ischaemia. Surgical risk analysis. Assessment of the Viability of the Limb. Contraindications for surgical revascularisation. Assessment of the risk of amputation (WIFI classification). Mangled Extremity Severity Score (MESS).
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Auditorium
|
2
|
Topics
|
Carotid and vertebral arterial disease. Arterial aneurysms. Abdominal aortic aneurysm. Acute aortic syndrome. Aortic dissection. Chronic venous disease. Acute and chronic deep vein thrombosis. Diseases of mesenteric arteries and veins.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Auditorium
|
2
|
Topics
|
Venous and lymphatic diseases of extremities – clinical course, diagnostics and treatment. Trophic ulcers.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Auditorium
|
2
|
Topics
|
Traumatic injuries of abdominal organs (traumatic injuries of liver, spleen, pancreas, intestinal ruptures etc.).
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Auditorium
|
2
|
Topics
|
Acute and chronic disturbances of mesenteric blood supply.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Auditorium
|
2
|
Topics
|
Chronic pancreatitis, pancreatic tumors. Clinical signs, diagnostics, treatment.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Spotlights in the diagnosis and treatment of brachiocephalic arteries, abdominal aortic aneurysms, venous disease and diseases of mesenteric vessels. Analysis of current international vascular surgical guidelines, using ESVS Guidelines on Management of Atherosclerotic Carotid and Vertebral Artery; ESVS Guidelines on Management of Abdominal Aortic Aneurysms; ESVS Guidelines on Management of Chronic Venous Disease; ESVS Guidelines on Management of the Diseases of Mesenteric Arteries and Veins.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Topicalities in the diagnosis and treatment of peripheral artery diseases. Analysis of current international vascular surgical guidelines, using Trans-Atlantic Inter-Society Consensus (TASC) Guidelines; ESVS Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Diseases of veins and lymphatic vessels of the lower extremity. Diagnostics and treatment. Complications (thrombosis, thrombophlebitis, deep vein insufficiency, trophical ulcers). Gangrene. Diagnostics and treatment. Interpretation of angiography results in the detection of surgical treatment tactics in patients with arterial pathology.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Signs of traumatic injuries of abdomen. Possibilities of diagnostics of closed abdominal trauma, surgery tactics. Possibilities of diagnostics of opened abdominal trauma, surgeon tactic. Polytrauma.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Colorectal cancer and premalignant diseases. Clinical picture and surgeon tactic dependent on colorectal cancer localization. Radical and palliative operated patient discussion.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Peritoneal adhesions. Intestinal fistulas. Care of the stoma patients. Clinical picture, diagnostics and surgical treatment.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Chronic pancreatitis. Tumors of the pancreas. Clinical picture, diagnostics, treatment.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Gastric cancer and premalignant diseases. Diagnosis and differential diagnostics. Importance of early diagnosis. Surgery principles: radical and palliative.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
4
|
Topics
|
Gastrointestinal bleeding. Zollinger – Allisone syndrome. Differences of the bleeding from upper and lower gastrointestinal tract.
|
Total ECTS (Creditpoints):
4.50
Contact hours:
48 Academic Hours
Final Examination:
Exam (Written)
Bibliography
Required Reading
1.
Lekciju materiāli e-vidē
2.
Mācību grāmata “Ķirurģija”, prof. J.Gardovska redakcijā, 2013.
3.
Bergan J. J., Bunke-Paquette N. (2014) The Vein Book. Oxford University Press. 555 pp.
4.
Townsend, C. M., Beauchamp, R. D., Evers, B. M., Mattox, K. L. (2017) Sabiston Textbook of Surgery (20th ed.). Elsevier.
5.
Zollinger`s. Atlas of Surgical Operations. 10th ed. – McGraw-Hill Education – Europe, 2016.
Additional Reading
1.
Mann C.V., Russell R.C.G. Bailey & Love’s Short Practice of Surgery 27th ed. London, Champan & Hall Medical, 2018.
2.
Brunicardi F, & Andersen D.K., & Billiar T.R., & Dunn D.L., & Kao L.S., & Hunter J.G., & Matthews J.B., & Pollock R.E.(Eds.), (2019). Schwartz's Principles of Surgery, 11e. McGraw-Hill.
3.
The Cancer Handbook. Ed. by Malcolm R.Alison - 2th ed. - Wiley, 2007.
4.
John L. Cameron, Andrew M. Cameron. Current Surgical Therapy: Expert Consult - Online and Print 12th Revised edition. Churchill Livingstone Inc, 2017.
5.
Acute Care Surgery: Principles and Practice. Ed. by L.D.Britt. – Springer, 2010.
6.
Laparoscopic Surgical Oncology. Ed. by Theodore T.Pappas, Emmanouel Leandros. - McGraw-Hill, 2005.
7.
Laparoscopic Colorectal Surgery. Ed. by Jeffrey W.Milsom, Bartholomaus Bohm, Kiyokazu Nakajama - 2th ed. - Springer, 2006.
8.
Laparoscopic Surgery. Ed. by Jorge Cueto-Garsia, Mosies Jakobs, Michel Gagner. - McGraw-Hill, 2003.
9.
Laparoscopic Surgery: Principles and Procedures Ed. by Daniel B.Jomes, Justin S.Wu, Nathaniel J.Soper - 2th ed. – Marcel Dakker, 2004.
10.
Imaging and Intervention in Abdominal Trauma Foreword by A.L. Baert, Edited by Robert F. Dondelinger. Springer-Verlag Berlin and Heidelberg GmbH & Co. K, 2003.
11.
Neatliekamā medicīniskā palīdzība. Traumas 1.izdevums. D.Krieviņa redakcijā, 2001, Rīga.
12.
Chaikof E. L., Cambria R. P. (2014) Atlas of Vascular Surgery and Endovascular Therapy: Anatomy and Technique. Elsevier Sounders. 800.pp.
13.
Dieter R. S., Dieter R. A. Jr., Dieter III R. A. (2011) Venous and Lymphatic Diseases. Mc Graw-Hill Companies Medical. 669 pp.
14.
Gloviczki P., ed. (2017). Handbook of Venous and Lymphatic Disorders: Guidelines of the American Venous Forum, Fourth Edition. CRC Press Taylor&Francis Group. 815 pp.
15.
Lācis A. (2004). Perifērisko artēriju okluzīvo slimību diagnostika un ārstēšana. SIA Nacionālais medicīnas apgāds. Rīga. 175 lpp.
16.
Greenhalgh R. M. (2012) Vascular and Endovascular Controversies Update. BIBA Medical Ltd Publishing. 719 pp.
17.
Lockhart M. E., Deurdulain C., Bhatt S., Lyshchik A. (2019) Diagnostic Ultrasound Vascular. Elsevier. 630 pp.
18.
Rutherford R. B., ed. (2005). Vascular Surgery. Sixt edition. Elsevier Saunders. Vol.1. 1-1270 pp., Vol. 2. 1271 – 2502 pp.
19.
Zarins C. K., Gewertz B. L. (2005). Atlas of Vascular Surgery. Second Edition. Elsevier. Churchill Livingstone. (USA). 292 pp.
20.
Chat V Dang, MD; Jeff Wade Understanding the Etiology and Pathophysiology of Acute Mesenteric Ischemia, Medscape Jia-Ming Wang, Shih-Chieh Chang. n engl j med 364;14 nejm.org april 7, 2012
21.
Wang J, Sun Y, Bertagnolli MM. Comparison of gastric cancer survival between Caucasian and Asian patients treated in the United States: results from the Surveillance Epidemiology and End Results (SEER) database. Ann Surg Oncol 2015; 22: 2965-71.
Other Information Sources
1.
RSU abonētās medicīnas literatūras datubāzes
2.
2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) https://www.ejves.com/article/S1078-5884(17)30454-9/pdf?code=yejvs-site
3.
Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery. http://www.lfb.lv/files/ESVS-AAA-guidelines.pdf
4.
Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011 Jan; 41 Suppl 1: S1-S58.
5.
Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2018, 1-97.
6.
Management of Chronic Venous Disease Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). https://www.ejves.com/article/S1078-5884(15)00097-0/pdf
7.
Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). https://www.sciencedirect.com/science/article/pii/S1078588417300588
8.
Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) https://www.ejves.com/article/S1078-5884(17)30395-7/pdf
9.
Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. J Vasc Endovasc Surg. 2019 (58). S1-S109.
10.
European Society for Vascular Surgery (ESVS) Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections Eur J Vasc Endovasc Surg 2020 (59), 339-384.
11.
Practice Management Guidelines for the Evaluation of Blunt Abdominal Trauma: EAST Practice Managment Guidelines Work Group. J Trauma. 53(3): 602-615, September 2002. https://www.east.org/education/practice-management-guidelines/blunt-abdominal-trauma%2C-evaluation-of
12.
Polytrauma managment Guidelines - Initial management of the polytrauma patient. Jonathan McGregor-Riley, Abu Hassan and Biniam Tesfayohannes. Surgery, 2012. https://www-clinicalkey-com.db.rsu.lv/#!/content/journal/1-s2.0-S026393191200083X
13.
Article - Initial management of the polytrauma patient. Jonathan McGregor-Riley, Abu Hassan and Biniam Tesfayohannes Surgery, 2012-07-01, Volume 30, Issue 7, Pages 320-325, Copyright © 2012 Elsevier Ltd. https://www-clinicalkey-com.db.rsu.lv/#!/content/journal/1-s2.0-S026393191200083X
17.
American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: Evidence-Based Report on Diagnostic Guidelines http://journals.lww.com/pancreasjournal/pages/articleviewer.aspx?year=2014&issue=11000&article=00006&type=abstract
18.
English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0041-107379
19.
Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. http://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Cancer-of-the-Pancreas
20.
ESMO Consensus Guidelines for the Management of Patients with Metastatic Colorectal Cancer. http://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Management-of-Patients-with-Metastatic-Colorectal-Cancer
21.
Early Colon Cancer: ESMO Clinical Practice Guidelines http://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Early-Colon-Cancer
22.
Rectal Cancer: ESMO Clinical Practice Guidelines http://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Rectal-Cancer
24.
The biology of adhesion formation in the peritoneal cavity. Kelli M. Braun MD and Michael P. Diamond MD Seminars in Pediatric Surgery, 2014-12-01, Volume 23, Issue 6, Pages 336-343, Copyright © 2014 Elsevier Inc. https://www-clinicalkey-com.db.rsu.lv/#!/content/journal/1-s2.0-S1055858614000316
25.
Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group https://wjes.biomedcentral.com/articles/10.1186/1749-7922-8-42
26.
Intra-abdominal Adhesions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992017/
27.
Guides for stoma care (see PDF files below in the link provided). http://www.securicaremedical.co.uk/Menu/Health-Professionals.aspx
29.
Basic ostomy skin care.Wound Ostomy and Continence Nurses Society (WOCN). http://www.ostomy.org/Ostomy_Information.html
30.
Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up http://www.esmo.org/Guidelines/Gastrointestinal-Cancers/Gastric-Cancer
31.
Cancer Research UK. https://www.cancerresearchuk.org/ health-professional/cancer-statistics/statistics-by-cancer-type/ stomach-cancer/survival heading-Two.
32.
Balakrishnan M, George R, Sharma A, Graham DY. Changing trends in stomach cancer throughout the world. Curr Gastro- enterol Rep 2017; 19: 36.
33.
Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019 Apr 15;144(8):1941-1953.
34.
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, Accessed 09 October 2018.
35.
Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 countries. CA Cancer J Clin 2018 Nov;68(6):394-424
36.
NICE guidelines for upper GI bleeding. https://www.nice.org.uk/guidance/conditions-and-diseases/digestive-tract-conditions/upper-gastrointestinal-bleeding
37.
Management of Patients with Acute Lower Gastrointestinal Bleeding. Strate LL, Gralnek IM. 2016;111(4):459-474. doi:10.1038/ajg.2016.41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099081/
38.
Current Treatment of Lower Gastrointestinal Hemorrhage. Raphaeli T, Menon R.Clinics in Colon and Rectal Surgery. 2012;25(4):219-227. doi:10.1055/s-0032-1329393. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577609/
39.
Evidence-based clinical practice guidelines for chronic pancreatitis 2015. Journal of Gastroenterology. February 2016, Volume 51, Issue 2, pp 85–92 https://link.springer.com/article/10.1007/s00535-015-1149-x
40.
Howlader NA, Krapcho M, Miller D, et al. SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017.