Every surgery requires preparation—both general for all types of endoscopic interventions and specific to the specific procedure. Preparation begins with diagnostics, preoperative examination, and clinical testing, which are mandatory for planned hospitalization. The patient's personal role in preoperative preparation is crucial. In addition to a positive psychological attitude ("everything will be fine!"), patients can be advised to take measures that enhance the body's nonspecific resistance mechanisms ("resilience"). For example, taking Eleutherococcus extract once daily for 3-4 weeks, or taking a two- to three-week course of vitamin therapy with multivitamins or, better yet, natural vitamin-containing foods and juices. Taking tinctures of aralia, rimantadine, and arbidol may also be recommended. The evening before surgery, be sure to shower, especially thoroughly washing the navel, and change underwear. A passport is required for hospitalization. On the eve of surgery, eat only liquids at lunchtime, and drink only liquids (tea, juice, mineral water) in the evening at 5:00 PM. If the surgery is performed under local anesthesia, there are no dietary restrictions the day before. Do not eat or drink on the morning of the surgery. Remove all metal jewelry and watches on the day of surgery and give them to a relative or the head nurse for safekeeping. If you have removable dentures, they must be removed. Below is a brief description of the diagnostic and laboratory tests most commonly performed to diagnose various surgical pathologies. Research required for hospitalization: — Blood test: general clinical (2 weeks), — Blood type, Rh factor, RW (Wasserman reaction - syphilis), HIV (human immunodeficiency virus - AIDS), Australian antigen and antibodies to hepatitis C (2 weeks), — Blood sugar (4 weeks), blood for total protein, bilirubin, electrolytes (K+, Na+, Ca++), ALT, AST (4 weeks), coagulogram - blood clotting (2 weeks). — Urethral smear for Gn (gonococci) and microbiocenosis, cervical canal culture for mycoplasma, chlamydia, other microflora (in gynecological pathologies). — Urinalysis - general (4 weeks), Zimnitsky test, daily urine, bacteriuria. — Stool analysis, stool microscopy. — Studies of bile, gastric juice, gastric secretion, — Chest radiography or fluorography (six months). X-ray of various organs and systems, with or without contrast. — Angiography. Computed tomography and nuclear magnetic resonance imaging. — Functional research methods: electrocardiogram (4 weeks), vectorcardiography (VCG), — echocardiography (ECHOCG), — phonocardiography (PCG). — Endoscopic studies: — Ultrasound examination (US). — A physician's conclusion on the absence of contraindications to surgical treatment (one month). Blood sampling for all types of tests is usually performed in the morning, i.e. before the patient takes food, medications, physiotherapy procedures, or exercise therapy. Exceptions are urgent tests, as well as repeated hourly tests throughout the day: for sugar, amylase, components of the blood coagulation system. Blood is taken from a vein with the patient lying down. A complete blood count includes: determination of hemoglobin and ESR (erythrocyte sedimentation rate), red blood cell count, white blood cell count, and white blood cell count. Platelet and reticulocyte counts are performed as prescribed by a doctor. Some normal blood parameters: — Blood type - four groups (0, A, B, AB), — Rhesus factor - positive: Rh (+) and negative Rh (-), RW (Wasserman reaction). The norm is negative. Positive (various number of "crosses") indicates syphilis. — HIV (human immunodeficiency virus - AIDS). The norm is negative. — Australian antigen and hepatitis C antibodies. The norm is negative. — Erythrocytes - 4-6 x 1012/l. — Leukocytes 4 - 8.8 109/l. — Hemoglobin - 120-160 g/l. — Hematocrit - 37-40% — ESR (erythrocyte sedimentation rate) 10-15 mm/h — Total protein - 1.9 mmol/l or 65-85 g/l, — ABB - a multicomponent study reflecting the acid-base balance of the blood. The main indicator is pH (normal = 7.36-7.44) The quality of urine testing depends on compliance with the rules for its collection, storage and timely delivery to the laboratory. Urine collection for general analysis is carried out in the morning after thorough hygienic toilet (for women - light vaginal tamponade; urine testing is not recommended during menstruation), the amount of urine is about 100 ml. The morning portion of urine is collected in a clean container and delivered to the laboratory within 30 minutes to 1 hour. Long-term storage of urine leads to a change in its physical properties, bacterial proliferation and the destruction of sediment elements. A general urine analysis includes: determination of its color, transparency, density, acid-base balance (pH), content of protein, sugar (glucose), urobilin, bile pigments, and microscopic examination of the sediment. A 24-hour urine collection (test of kidney function) is performed. The first morning portion of urine is not collected, but the time of urination is noted. Subsequent portions of urine are collected in one container throughout the day. The final urine collection is performed in the morning of the following day at the time noted the day before. The urine is shaken, its total daily volume is measured, and approximately 200 ml is delivered to the laboratory; the daily amount is indicated on the label. Determination of bacteriuria (the number of bacteria in urine). Urine is collected in a sterile container after thorough toilet. A midstream portion of urination is collected from both women and men, and the first portion, which washes the urethra, is discarded. In seriously ill patients, urine is collected with a sterile catheter, and the time of collection is indicated. Zimnitsky test (kidney function test). No special diet or drinking restrictions are prescribed. Urine is collected throughout the day, every 3 hours in separate containers. The portion number and time interval are marked on each. The last portion is from 3:00 a.m. to 6:00 a.m. A total of 8 portions are collected. It is important to conduct the analysis quickly after the end of the urine collection. In the laboratory, the density and amount of urine are determined in each portion. Some normal urine test parameters: - Daily amount: women 600-1600 ml, men 800-1800 ml - Relative density of urine in the morning portion 1008-1026 - Maximum relative density according to the Zimnitsky test is above 1020 - Color: straw-yellow, transparent. — Reaction (pH) neutral, slightly acidic, slightly alkaline, 6.25±0.3b (4.5-8.0) — Protein is absent or in traces, sugar, acetone, ketone bodies, urobilin bodies, bilirubin, ammonia and hemoglobin are absent. — Transitional epithelium - insignificant amount — Renal epithelium is absent — Erythrocytes 0-2 in the preparation — Leukocytes 0-3 (male) and 0-6 (female) in the field of vision — No casts — Insignificant amount of mucus — Absent or insignificant amount of bacteria (no more than 50,000 in 1 ml) General stool analysis: reaction to occult blood, determination of bile pigments, test for helminth eggs, etc. Stool is collected in the morning in a clean, dry glass or plastic container with a wide opening, with a lid, it must be quickly delivered for analysis - with prolonged storage, changes occur in it under the influence of microbes and enzymes. Stool cannot be collected after an enema. Stool collection for bile pigments (quantitative determination of stercobilin - liver function) is performed in the same way as for a general analysis. The following parameters are normal in a stool test: — Daily amount 100-250 g — Neutral or slightly alkaline reaction — No bilirubin — Coproporphyrin 200-300 ?g — No mucus, blood, or protein — Stercobilin 40-280 mg — No muscle fibers or individual digested fibers that have lost their striation — No connective tissue, neutral fat, and fatty acids, starch, iodophilic flora, mucus, or epithelium. — Insignificant amounts of soap — Single leukocytes in the sample — No pathogenic microbes of the intestinal family — Total number of E. coli 107-108 X-ray studies are based on the penetration of invisible electromagnetic rays with a wavelength of 0.0005-100 nm through tissues and are named after their discoverer (1895), Wilhelm Roentgen. Due to the varying degrees of absorption of rays by different tissues, an image is formed on X-ray film or in a digital converter. Rays are absorbed to a greater extent by bone tissue, to a lesser extent by soft tissue, and very little is absorbed by air. For the patient, a rather important distinction between the group of X-ray diagnostic examinations (fluorography, radiography, computed tomography and nuclear magnetic resonance imaging) can be the following: with or without the use of contrast. Methods of administration of the contrast agent: orally (through the mouth - in the form of a liquid or paste), intravenously, by enema, directly into the lumen of the organ (usually during surgery). Examination of the stomach and small intestine. The evening before, a light dinner is recommended, excluding milk, fruits, and vegetables. The examination is performed strictly on an empty stomach; it is necessary to avoid liquid intake, smoking, and oral medications. During the examination, a barium suspension is taken orally. Large intestine (enema with contrast): a low-residue, low-fiber diet is prescribed two days before the examination. On the eve of the examination, after lunch, the patient takes 30-40 g of castor oil (if there are no signs of intestinal obstruction). At night (30-40 minutes after dinner), a large cleansing enema is given. In the morning, no later than 2 hours before the examination, a repeat cleansing enema is given. If you are prone to flatulence, enemas with chamomile infusion are recommended. Ileocecal junction (the transition between the small intestine and the large intestine). The first portion of the contrast agent (barium sulfate, 200 g) is taken orally in the ward in two doses, 6 and 5 hours before the examination (6 and 7 a.m.). Breakfast is eaten after taking the barium sulfate. Angiographic studies (X-rays of blood vessels) are performed under anesthesia. Before the examination, premedication is administered (medications are administered to prepare the patient for anesthesia), and the skin at the site of contrast injection into the vascular bed (usually the lower abdomen, pubic area, or upper thighs) is shaved. The examination is performed strictly on an empty stomach. Biliary tract examinations. Contrast of the biliary tract can be intravenous or oral (administration of BILOPTIN or another oral contrast agent). In both cases, a low-residue diet is prescribed two days before the examination. The examination itself is performed on an empty stomach. Urinary tract examinations - excretory urography. A low-residue diet is prescribed two days before the examination, the examination is performed on an empty stomach, 30 g of castor oil is taken the day before, and an enema is given. Another enema is given 40 minutes before the examination. X-ray examinations and computed tomography are always or sometimes performed without contrast: brain, chest, liver and gallbladder, pancreas, kidneys. Computed tomography (CT) is a specific type of X-ray examination. A rotating X-ray source emits a series of pulses within a ring-shaped housing. The images obtained from various angles are digitized and analyzed by a computer. The computer then produces images as cross-sections of human tissue in various planes and at different levels. The radiation dose in CT is somewhat higher than in X-rays, but its information yield is also many times greater than that of conventional X-rays. An even more informative and expensive examination method is nuclear magnetic resonance imaging (NMR), which utilizes the resonant absorption of electromagnetic waves by atoms. Computer processing of a series of images is also used. Due to radiation dose considerations, the high cost (US$0.5-1.5 million), and limited availability of equipment, CT and NMR scans are prescribed for strict indications in cases of a controversial diagnosis or the ineffectiveness of other examination methods. Functional diagnostic methods are performed in the functional diagnostics department and are so called because the specialist uses their data to analyze not the external state, but the activity—the function—of the organ. To examine cardiac function, electrocardiography (ECG), 24-hour ECG monitoring (the so-called Holter monitor), stress tests (ECG stress tests during measured physical exertion), vectorcardiography (VCG), echocardiography (ECHO), and phonocardiography (PCG) are performed. These provide a picture of the overall condition of the heart muscle and coronary vessels and help identify a wide range of rhythm disorders, blood supply, and nerve conduction. Oscillography, rheography, rheoencephalography, and black-and-white and color Doppler ultrasound are also used to determine the condition of the vessels, their walls, valves, and vascular patency. These studies reflect the tone of the wall and vascular patency. Endoscopic examinations (endo - inside, skopeo - I look) allow for an external examination of the body's natural cavities, tissue biopsy, drug therapy, and even surgical treatment of a number of pathologies. If the word-forming particle fibro (fibro - fiber) is added to the name of the examination, this indicates that the examination is performed with a flexible fiber-optic endoscope - fibroscopy. Fibroscopes with a diameter of 8-12 mm are used to examine the stomach, duodenum, and bronchi, the colon is examined with devices with a diameter of 12-14 mm, and the urinary tract - with devices with a diameter of 3-4 mm. Individual methods are named after the organ being examined: - gastroscopy (fibrogastroscopy) - examination of the esophagus and stomach (gaster - stomach), - duodenoscopy (fibroduodenoscopy) - examination of the duodenum. Sometimes called fibroesophagogastroduodenoscopy, listing under one name all the organs available for examination and manipulation (esophagus - esophagus, gastro - stomach, duodeno - 12 intestines), - choledochoscopy (fibrocholedochoscopy) - examination and manipulation in the common bile duct - the common bile duct, performed during open or endoscopic surgery, - laparoscopy - diagnostic or surgical intervention - abdominal cavity, - bronchoscopy (fibrobronchoscopy) - examination of the trachea and bronchial tree, - nasopharyngoscopy - examination of the nasopharynx (nasum - nose, pharynx - pharynx), - cystoscopy (can be performed with either a flexible apparatus or a rigid optical tube with a diameter of 4 mm or 2.7 mm) - examination of the bladder (cysto), - urethroscopy (fibroureteroscopy) is an examination of the urethra (urethra), often performed with a cystoscope during cystoscopy. - ureteroscopy and nephroscopy (fibroureteroscopy) are an examination of the ureters and kidneys (urether - ureter, nephro - kidney), - hysteroscopy (there are both fibrohysteroscopes and rigid hysteroscopes) is an examination of the uterine cavity (hystera - uterus), - arthroscopy is an examination and surgery in joint cavities with a rigid endoscope with a diameter of 1.7 to 4 mm (arthro - joint), - colonoscopy (fibrocolonoscopy) is an examination of the large intestine (colon - large intestine) with a flexible endoscope, - rectoscopy is an examination of the rectum and sigmoid colon with a rigid endoscope. Upper gastrointestinal tract examinations are performed on an empty stomach. To suppress the gag reflex during fibroscopic examination, the oropharynx is anesthetized locally (using aerosol anesthetics such as lidocaine or xylocaine). Basic laboratory tests are required for fibroscopic examinations (see the beginning of the article). For a lower gastrointestinal tract fibroscopic examination, a low-residue diet is prescribed the day before, 30-40 g of castor oil is taken 8 hours before, three cleansing enemas are administered the evening before, and three more in the morning. For a rectoscopy (rigid endoscopy), only one enema is administered before the examination. In addition to diagnostic procedures, fibroscopes can be used for a variety of therapeutic procedures. For example, in the case of ulcerative bleeding, coagulation of the bleeding vessel can be performed. Фиброскопом может быть наложена эндоскопическая гастростома - выведение на переднюю брюшную стенку трубки для временной подачи пищи непосредственно в желудок, минуя пищевод. При помощи фибродуоденоскопа выполняется папиллотомия - разрез Фатерова соска (место впадения холедоха - общего желчного протока в двенадцатиперстную кишку) и извлечении из холедоха желчных камней. Во время колоноскопии могут быть удалены единичные полипы толстой кишки. И это только краткий иллюстративный перечень лечебных возможностей фиброэндоскопии. Ультразвуковые исследования (УЗИ) являются современным, весьма информативным и практически безопасным методом исследования. Принцип его заключается в том, что источник ультразвука (то есть звукового колебания с частотой более 20 кГц - не воспринимаемой человеческим ухом) посылает волну в ткани и органы. Одним типом ткани волна поглощается, от других она отражается, третьи - пропускают ее практически без изменений. Отраженный ультразвуковой сигнал возвращается обратно и воспринимается датчиком аппарата. Полученный сигнал претерпевает компьютерную обработку и воспроизводится на экране монитора в виде УЗ изображения. Особенно информативно УЗИ при обследовании желчного пузыря, печени, поджелудочной железы, сердца, почек, селезенки, матки, простаты, щитовидной железы. Специальной подготовки не требует, кроме УЗИ мочеполовой системы - необходимо выполнять при наполненном мочевом пузыре. Необходимым условием для госпитализации в стационар с последующим оперативным лечением является осмотр и заключение терапевта об общем состоянии пациента. Терапевт устанавливает наличие общих абсолютных или относительных противопоказаний к выполнению операции, что позволяет хирургу скорректировать в дальнейшем тактику лечения и выбрать наиболее оптимальный тип вмешательства.