Instrumentacion Quirurgica III


Guide N 3

The Human Heart

The human heart is a muscle that lies left of the chest . It has about the size of a fist . The heart is like a pump that sends blood around your body. The blood gives you the oxygen you need . An average heart pumps about 70 millilitres of blood into your body with every beat . That’s about 5 litres every minute or about 7200 litres every day.


Parts of the heart

The heart is made up of 4 chambers . There are two chambers on each side of the heart. The top two chambers are called the atria. They fill with blood. The two chambers at the bottom of the heart are called ventricles. Their job is to squirt out the blood. In the middle of the heart there is a thick muscle called the septum that separates the left and the right side.

The atria and ventricles work together. The atria fill with blood and when they are full they let the blood into the ventricles. When these ventricles pump the blood out of the heart, the atria fill up again and the whole process starts again.

There are valves in the heart that make sure that the blood is pumped in the right direction. When the heart contracts , it pumps blood from its chambers into the body. Then the heart muscle relaxes and lets the chambers fill up.


Blood circulation
Every cell in your body needs oxygen to live. The role of the heart is to send blood that is full of oxygen to all the cells in your body.

The passageways that carry this blood are called blood vessels. Arteries carry oxygen-rich blood to the cells that need it. The largest artery is the aorta. Veins carry blood back to the heart again. It is pumped into your lungs where it picks up oxygen and then goes back to your heart, from where it is pumped back again into your body.

It only takes about 20 seconds to pump blood to every cell of your body.


Your heartbeat
Even though your heart is inside you, you can see it work by feeling your pulse. You can find your pulse in many parts of your body. It’s best to press your finger on the inside of your hand, just below the thumb. You can feel a small beat under your skin. This is caused by the contraction of your heart.

When you rest or sleep your heart does not beat that fast—about 60 to 80 beats a minute. When you run around a lot your heart pumps more blood into your body—maybe up to 200 times a minute.


Changing heart rates


As people grow older their heart rates change. A newborn baby has a heart rate of about 130, a three-year old has about 100 and an eight-year old’s heart beats about 90 times a minute. An adult has a heart rate of about 70 to 80. The older you get the slower your heart beats.



Heart attack
Your heart is probably the most important part of your body. If it stops pumping blood you cannot survive .

The greatest danger for your heart is a heart attack. It happens suddenly and is like an explosion. When the heart stops pumping blood, muscles must die because they cannot get any oxygen.

In some cases blood is not able to flow through the blood vessels because they are clogged up. So the heart does not get enough blood to work. Chest pain may be a possible warning sign of an upcoming heart attack.



How to keep your heart healthy
Most people are born with a healthy heart, but it’s important to keep it healthy.

Your heart is a muscle. It needs exercise . About twenty minutes of exercise a day will keep it strong and healthy.
Eat different kinds of food and don’t eat too much fat.
Smoking is bad for your heart.


Words

adult = a grown up person
artery = a path that carries blood from the heart to the body
average = normal
beat =rhythm, pounding of the heart
caused =to be done because of
cell = a very small part of something living
chamber = a part of the heart that is separated from other parts by a thin muscle
chest =the front part of your body between your neck and your stomach
clog =block, stop
contract = to become smaller
contraction = to make something smaller
fist = if you press your hand together to make it round like a ball you call this a fist
flow =run
heart rate = the number of times your heart beats every minute
make sure =here: control
oxygen = is in the air that we breathe
pain =if something hurts you
passageway = small ways or paths through the body
pick up =to take along with it
press = to push hard on something
process =the actions that re done to achieve something
relax = rest
separate =divide
squirt out =if a liquid comes out very quickly
suddenly = if something happens very surprisingly
survive = to stay alive
upcoming = if something is going to happen soon
valve =part of a tube or pipe that opens and closes and controls how much air or water goes through it

Actividad 1:

a)   Lea el título del texto y escríbalo en español.
………………………………………………………………………………………..

b)   A partir del título, ¿sobre qué le parece que tratará el texto?
…………………………………………………………………………………………
…………………………………………………………………………………………

c)   Observe en los textos las palabras transparentes y márquelas con un color.


Las palabras transparentes son las que son similares en Inglés y en Español;
 por lo que podemos inferir su significado fácilmente.
d)         Observe las palabras conocidas y márquelas con otro color.
            Las palabras conocidas son aquellas que Ustedes ya conocen en Inglés.
e)         Busque en el diccionario el significado de las siguientes palabras.

·    artery.:  …………………………………………………………………………

·    beat: …………………………………………………………………………..

   ventricules: ………………………………………………………………………..

   chest: ……………………………………………………………………………

·    fist: ………………………………………………………………………….

·    blood: ……………………………………………………………………….

·    contract: …………………………………………………………………………
 Marque lo siguiente


1. GV con voz pasiva
2. GV con verbo modal
3. GV en presente simple.
4. GV con el verbo ser o estar.
5. GV con el verbo 


GUIA 4

Guía de Trabajo 4
GASTROINTESTINAL SURGERY FOR  SEVERE OBESITY
Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Gastrointestinal surgery is an option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems. The operation promotes weight loss by restricting food intake and, in some operations, interrupting the digestive process. As in other treatments for obesity, the best results are achieved with healthy eating behaviors and regular physical activity.

HOW DOES SURGERY PROMOTE WEIGHT LOSS?

Gastrointestinal surgery for obesity, also called bariatric surgery, alters the digestive process. The operations can be divided into three types: restrictive, malabsorptive, and combined restrictive/malabsorptive. Restrictive operations limit food intake by creating a narrow passage from the upper part of the stomach into the larger lower part, reducing the amount of food the stomach can hold and slowing the passage of food through the stomach. Malabsorptive operations do not limit food intake, but instead exclude most of the small intestine from the digestive tract so fewer calories and nutrients are absorbed. Malabsorptive operations, also called intestinal bypasses, are no longer recommended because they result in severe nutritional deficiencies. Combined operations use stomach restriction and a partial bypass of the small intestine.
WHAT ARE THE SURGICAL OPTIONS?

There are several types of restrictive and combined operations. Each one has its own benefits and risks.

RESTRICTIVE OPERATIONS

Purely restrictive operations only limit food intake and do not interfere with the normal digestive process. To perform the operation, doctors create a small pouch at the top of the stomach where food enters from the esophagus. At first, the pouch holds about 1 ounce of food and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ½ inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness.
After the operation, patients can no longer eat large amounts of food at one time. Most patients can eat about ½ to 1 cup of food without discomfort or nausea, but the food has to be soft, moist, and well chewed. Patients who undergo restrictive procedures generally are not able to eat as much as those who have combined operations.

Purely restrictive operations for obesity include adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG).
  1. Adjustable gastric banding. In this procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach (figure 2). The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.
  2. Vertical banded gastroplasty. VBG uses both a band and staples to create a small stomach pouch, as illustrated in figure 3. Once the most common restrictive operation, VBG is not often used today.
Descripción: Figure 3. Diagram of vertical banded gastroplastyAdvantages: Restrictive operations are easier to perform and are generally safer than malabsorptive operations. AGB is usually done via laparoscopy, which uses smaller incisions, creates less tissue damage, and involves shorter operating time and hospital stays than open procedures. Restrictive operations can be reversed if necessary, and result in few nutritional deficiencies.
Disadvantages: Patients who undergo restrictive operations generally lose less weight than patients who have malabsorptive operations, and are less likely to maintain weight loss over the long term. Patients generally lose about half of their excess body weight in the first year after restrictive procedures. However, in the first 3 to 5 years after VBG patients may regain some of the weight they lost. By 10 years, as few as 20 percent of patients have kept the weight off. (Although there is less information about long-term results with AGB, there is some evidence that weight loss results are better than with VBG.) Some patients regain weight by eating high-calorie soft foods that easily pass through the opening to the stomach. Others are unable to change their eating habits and do not lose much weight to begin with. Successful results depend on the patient’s willingness to adopt a long-term plan of healthy eating and regular physical activity.
Risks: One of the most common risks of restrictive operations is vomiting, which occurs when the patient eats too much or the narrow passage into the larger part of the stomach is blocked. Another is slippage or wearing away of the band. A common risk of AGB is breaks in the tubing between the band and the access port. This can cause the salt solution to leak, requiring another operation to repair. Some patients experience infections and bleeding, but this is much less common than other risks. Between 15 and 20 percent of VBG patients may have to undergo a second operation for a problem related to the procedure. Although restrictive operations are the safest of the bariatric procedures, they still carry risk—in less than 1 percent of all cases, complications can result in death.
COMBINED RESTRICTIVE/ MALABSORPTIVE OPERATIONS
Combined operations are the most common bariatric procedures. They restrict both food intake and the amount of calories and nutrients the body absorbs.
  1. Descripción: Figure 4. Diagram of Roux-en-Y gastric bypassRoux-en-Y gastric bypass (RGB). This operation, illustrated in figure 4, is the most common and successful combined procedure in the United States. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. Rarely, a cholecystectomy (gall bladder removal) is performed to avoid the gallstones that may result from rapid weight loss. More commonly, patients take medication after the operation to dissolve gallstones.
  1. Descripción: Figure 5. Diagram of biliopancreatic diversionBiliopancreatic diversion (BPD). In this more complicated combined operation, the lower portion of the stomach is removed (see figure 5). The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure leads to weight loss, it is used less often than other types of operations because of the high risk for nutritional deficiencies. A variation of BPD includes a “duodenal switch” (see figure 6), which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway. The larger stomach allows patients to eat more after the surgery than patients who have other types of procedures.
Advantages: Most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more. With BPD, most studies report an average weight loss of 75 to 80 percent of excess weight. Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.
Disadvantages: Combined procedures are more difficult to perform than the restrictive procedures. They are also more likely to result in long-term nutritional deficiencies. This is because the operation causes food to bypass the duodenum and jejunum, where most iron and calcium are absorbed. Menstruating women may develop anemia because not enough vitamin B12 and iron are absorbed. Decreased absorption of calcium may also bring on osteoporosis and related bone diseases. Patients must take nutritional supplements that usually prevent these deficiencies. Patients who have the biliopancreatic diversion procedure must also take fat-soluble (dissolved by fat) vitamins A, D, E, and K supplements, and require life-long use of special foods and medications.
RGB and BPD operations may also cause “dumping syndrome,” an unpleasant reaction that can occur after a meal high in simple carbohydrates, which contain sugars that are rapidly absorbed by the body. Stomach contents move too quickly through the small intestine, causing symptoms such as nausea, bloating, abdominal pain, weakness, sweating, faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it may reduce the likelihood of dumping syndrome.
Risks: In addition to risks associated with restrictive procedures such as infection, combined operations are more likely to lead to complications. The risk of death associated with these types of procedures is lower for the gastric bypass (less than 1 percent of patients) than for the biliopancreatic diversion with duodenal switch (2.5 to 5 percent). Combined operations carry a greater risk than restrictive operations for abdominal hernias (up to 28 percent), which require a follow-up operation to correct. The risk of hernia, however, is lower (about 3 percent) when laparoscopic techniques are used.
Fuente: http://win.niddk.nih.gov/publications/gastric.htm



Actividades:
1-    Observe el título y los subtítulos. ¿Conoce algunas palabras? ¿Puede predecir de qué se trata el texto? Escriba sus ideas.
______________________________________________________________________________________________________________________________________________________________________________________________________
2-    Observe los dibujos y figuras. ¿ Qué tipo de información le  proveen?
____________________________________________________________________________________________________________________________________
3-    ¿Qué  información conoce sobre el tema?
____________________________________________________________________________________________________________________________________
          

Actividades de Gramática

1-      Observe las siguientes palabras. Marque los sufijos y prefijos que encuentre. Diga a qué categoría gramatical pertenecen. Luego escriba las palabras en español.

a-      fullness ( línea 27) : __________________________
b-      discomfort ( línea 29): ________________________
c-      adjustable ( línea 33): _________________________
d-     unable ( línea 63): ____________________________
e-      successful ( línea 81): _________________________
f-       unpleasant ( línea 124): ________________________
g-      weakness ( línea 128): _________________________
h-      faintness ( línea 128): __________________________
i-        likelihood ( línea 130): _________________________



2-      Busque en el texto 4 ejemplos de grupos verbales con:

¯  Presente Perfecto
¯  Verbos Modales
¯  Voz Pasiva
Escriba los equivalentes en español.

3-      Lea el texto y decida a qué hacen referencia las siguientes palabras:

THAT ( línea 1): _______________________
WHO ( línea 2): ________________________
THEY ( línea 16): _______________________
ITS ( línea 19): _________________________
WHERE ( línea 23): _____________________
THOSE ( línea 31): ______________________
WHICH ( línea 49): ______________________
IT ( línea 98): ___________________________

4-      Lea las siguientes oraciones extraídas del texto. Marque los conectores y decida su función.
Luego escriba la oración en español.

a- Malapsorptive operations do not limit food intake, but instead exclude most of the small intestine from the digestive tract so fewer calories and nutrients are absorbed”.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________
b- After the operation, patients can no longer eat large amounts of food at one time.
__________________________________________________________________________________________________________________________________________________
c- However, in the first 3 to 5 years after VBG patients may regain some of the weight they lost.
__________________________________________________________________________________________________________________________________________________
d- Although there is less information about long-term results with AGB, there is some evidence that weight loss results are better than with VBG.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________
e- Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension, sleep apnea, type 2 diabetes, and osteoarthritis.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________

Actividades de Vocabulario:
1-      Observe las siguientes palabras extraídas del texto. Decida cuál es el significado de cada una de ellas de acuerdo al contexto en el cual se encuentra.

1-      POUNCH ( línea 22): a) parche
 b) bolsa
c) saca bocado
2-      OUTLET ( línea 24): a) salida
b) oferta
c) cañería
3-      MOIST ( línea 30): a) blanda
         b) húmeda
         c) abundante
4-      HOLLOW ( línea 36): a) vacía
 b) goma
 c) hundida
5-      STAPLES ( línea 44): a) grampas
 b) sin bandas
 c) estampas
6-      VIA ( línea 49): a) medio
   b) vía
   c) camino
7-      REGAIN ( línea 58): a) de nuevo
                                   b) recuperar
                                   c) regañar
8-      SLIPPAGE ( línea 68): a) zapatilla
               b) resbalón
               c) durabilidad
9-      LEAK ( línea 70): a) pérdida
                              b) rotura
                               c) gusto
10-  GALL BLADDER ( línea 88): a) cálculos
   b) vesícula biliar
   c) glándula
11-  PATHWAY ( línea 104): a) tracto
     b) camino
     c) tubo
12-  DUMPING ( línea 130):  a) descarga
      b) vaciado
      c) vertido
13-  INTAKE ( línea 5): a) ingesta
         b) alimento
         c) digestión


2-Busque en el diccionario el significado de los siguientes verbos en frase. Luego búsquelos en el texto, márquelos y corrobore su elección. 

Verbo en frase:  es el verbo que, seguido de una partícula, cambia su significado. Ejemplo:  “to look” significa “ver”
                            “to look for” significa “buscar”

a)      keep off
b)      wear away
c)      lead to
d)     bring on

Actividades de Comprensión

1-      Defina qué es la obesidad severa.
2-      ¿ Qué es la cirugía gastrointestinal?
3-      Busque en el texto un sinónimo de cirugía gastrointestinal.
4-      ¿ Cuáles son los tres tipos de cirugía gastrointestinal que nombra el texto? Defina cada uno de ellos.
5-      Realice un cuadro comparativo señalando las ventajas, desventajas y riesgos que presentan las operaciones restrictivas y las operaciones combinadas.


Forma –ing
Esta forma verbal cumple diferentes funciones en la oración y no siempre la traducción en español es equivalente a su función en inglés.

Como parte del presente/pasado continuo
Se traduce con la terminación “-ando”, “-endo”
Ej.: The lens is focusing the image of the object. (La lente está enfocando la imagen del objeto.)

Cuando introduce una idea que se agrega a la oración principal (va separado por una coma)
Bacteria are susceptible to antibiotics, depending on the structure of their cell walls (Las bacterias son susceptibles a los antibióticos, dependiendo de sus paredes celulares.)

Sustantivo + V-ing (se traduce por “Que + verbo conjugado”)
Ej.: The layer covering your eyes is composed of many cells.  (La capa que cubre tus ojos está compuesta de muchas células)

Sustantivo
Ej.: The understanding of biological phenomena is useful for  the studying of cells. .(La comprensión de los fenómenos biológicos es útil para el estudio de las células)

Adjetivo
Ej.: Modern microscopes use two magnifying lenses. (Los microscopios modernos utilizan dos lentes de aumento)

Preposición+V-ing (se traduce por “preposición + verbo en infinitivo”(o sea sin conjugar)

Ej.: The membrane plays an important role in controlling cell function.  (La membrana juega un importante papel al controlar la función celular.)
Sufijos y prefijos
Los sufijos son las terminaciones de las palabras. A través de ellos podemos determinar a qué clase pertenece  una  palabra: sustantivo, adjetivo, verbo o adverbio. En la siguiente lista aparecen los sufijos más comunes y típicos de cada clase.

sufijos                                                                                                      



-ance/ence                    -ate                                         -able/ible                              -ly                                
  -ion                               -ify/fy                                    -al/ial/ical
  -ity/ty/cy                       -ize/ise                                      -ar/iar
  -ment                                                                        -ary/ory
  -ness                                                                               -ful
  -ship                                                                                -ic
  -ist                                                                                 -less
  -er (verbo+er)                                                                -ous
  -ism                                                                                 -er
                                                                                        -est


Los prefijos anteceden a la raíz de una palabra y le cambian el significado. 
PREFIJOS                                                                                                   



un-                              semi-                           pre-                     mono-                     auto-/self-
non-                            mini-                           ante-                    bi-                           co-(junto)
in-                               macro-                        fore-                    hex-                        neo-(nuevo)
dis-                             micro-                         post-                    oct-                         mid-(medio)
de-                              maxi-                                                      multi-                      sub(por debajo)
mal-                                                                                           poly-                       bio-(vida)
il-/ill-


TERMINACIONES DE COMPUESTOS



INGLÉS              ESPAÑOL                                  EJEMPLO

-ane                             -ano                            methane ® metano
-ate                             -ato/ado                      chlorate ® clorato
                                                                       sulfurate ® sulfurado
-ene                             -eno                            benzene ® benceno
-ic                               -ico                             sulfonic ® sulfónico

-ide                             -ido                             monoxide ® monóxido

-ide                             -uro                             sulfide ® sulfuro
-ide                             -ida                             sulfonamide ® sulfonamida
-ine                             -ina                             reserpine ® reserpina
-ite                              -ito                              sulphite/sulfite ® sulfito
-ium                            -io                               sulfonium ® sulfonio
-oid                             -oide                           corticoid ® corticoide
-ole                             -ol                               sulfathiazole ® sulfatiazol
-one                            -ona                            cortisone ® cortisona
-ous                             -oso                             ferrous ® ferroso
-yl                               -ilo                              ethyl ® etilo












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