P tin appedectomy& hernia

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P tin appedectomy& hernia

  1. 1. Physiotherapy in abdominal surgery A.THANGAMANI RAMALINGAM PT, MSc(PSY), MIAP
  2. 2. Appendicectomy <ul><li>The appendix is a small finger-like projection that comes off the cecum of the large intestine and has no apparent function in the human. When the opening in the sac is blocked, it leads to an inflammation of the appendix called appendicitis . This condition occurs most commonly in the young, between childhood and young adulthood. Appendicitis is an emergency condition and requires urgent surgical removal of the appendix </li></ul><ul><li>Its position within the abdomen corresponds to a point on the surface known as  McBurney's point . </li></ul>
  3. 4. <ul><li>Positions </li></ul><ul><li>Retrocecal or retro colic </li></ul><ul><li>Pelvic or descending </li></ul><ul><li>Sub cecal </li></ul><ul><li>Pre&post ileal </li></ul><ul><li>Indications </li></ul><ul><li>Acute appendicitis </li></ul><ul><li>Recurrent /chronic </li></ul><ul><li>Appendicular mass </li></ul><ul><li>Tumours </li></ul><ul><li>Gangrene </li></ul><ul><li>Perforation </li></ul><ul><li>peritonitis </li></ul>
  4. 5. Incision <ul><li>Mcburney’s grid iron incision </li></ul><ul><li>Lanz’s transverse incision (cosmetic) </li></ul><ul><li>Rutherford Morrison's muscle cutting incision </li></ul><ul><li>laproscopy </li></ul>
  5. 7. <ul><li>Drains may or may not be </li></ul><ul><li>Wait for intestinal peristalsis heard for diet </li></ul>
  6. 8. Complications <ul><li>Wound infection </li></ul><ul><li>Abdominal abscess due to spillage of bacteria after a ruptured appendicitis </li></ul><ul><li>Bowel obstruction </li></ul><ul><li>Urinary tract infection </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Injury to the large or small bowel, ovary or other abdominal organs requiring removal </li></ul><ul><li>Subphrenic or pelvic abcess </li></ul><ul><li>Fecal fistula </li></ul>
  7. 9. Hernia <ul><li>A hernia is a protrusion of usually a loop of bowel or a tissue through an opening in the wall of the abdominal cavity in which the bowel lies. Hernias are one of the most common conditions requiring surgery. </li></ul><ul><li>Hernias can develop around the navel, in the groin, or any place where you may have had a surgical incision. Some hernias are present at birth. </li></ul>
  8. 10. Types of Hernia <ul><li>Inguinal hernia </li></ul><ul><li>Femoral hernia </li></ul><ul><li>Umbilical hernia </li></ul><ul><li>Incisional hernia </li></ul><ul><li>Epigastric hernia </li></ul><ul><li>Hiatus hernia </li></ul><ul><li>Strangulated hernia </li></ul>
  9. 13. Surgical Repair <ul><li>Herniotomy </li></ul><ul><li>Herniorrhapy </li></ul><ul><li>Hernioplasty </li></ul><ul><li>Laparoscopic </li></ul>
  10. 14. Complications <ul><li>Chronic pain may result from surgical handling of the sensory nerve in the groin area during surgery, or after surgery from constricting scar tissue </li></ul><ul><li>Infection </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Ischemic orchitis due to thrombosis of the spermatic cord and venous congestion produces pain and swelling </li></ul><ul><li>Recurrence of the hernia due to excessive tension during repair, inadequate tissue, inadequate repair, and overlooked hernias. Recurrence rates are 1-4% </li></ul>
  11. 15. Nephrectomy <ul><li>Removal of the kidney </li></ul><ul><li>Approaches </li></ul><ul><li>- Lumbar approach (common) –oblique from 12 th rib angle to ASIS </li></ul><ul><li>-Through the 12 th rib </li></ul><ul><li>-Nagamatsu incision(hockey stick fashion)-12 th rib removed ,extends upto 10 th rib </li></ul><ul><li>-Trans peritoneal approach </li></ul>
  12. 16. Indications <ul><li>Renal tumors </li></ul><ul><li>TB </li></ul><ul><li>Hydro nephrosis </li></ul><ul><li>Calculi </li></ul><ul><li>HTN </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Pyogenic infection </li></ul>
  13. 17. Complications <ul><li>Complications of any surgery such as heart attack, heart failure, stroke, pneumonia, blood clots in the legs and pulmonary embolism (blood clot to the lungs) </li></ul><ul><li>Injury to the stomach, small bowel or large bowel </li></ul><ul><li>Tears of the liver </li></ul><ul><li>Injury to the spleen </li></ul><ul><li>Injury to the pancreas with pancreatitis </li></ul><ul><li>Bowel obstruction may occur </li></ul><ul><li>Ileus (temporary loss of bowel function) </li></ul><ul><li>Hemorrhage which may be severe </li></ul><ul><li>Pneumothorax (puncture of the lung) </li></ul><ul><li>Infection </li></ul><ul><li>Temporary loss of renal function of the other kidney </li></ul><ul><li>Incisional hernia  </li></ul>
  14. 18. <ul><li>Chemotherapy </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Immunotherapy </li></ul>
  15. 19. Operations on small intestine <ul><li>Enterotomy </li></ul><ul><li>Enterectomy </li></ul><ul><li>End to end anastomosis </li></ul><ul><li>Side to side anastomosis </li></ul><ul><li>Oblique anastomosis </li></ul><ul><li>End to side anastomosis </li></ul><ul><li>Enterostomy- jejunostomy / ileostomy </li></ul><ul><li>Ileostomy </li></ul><ul><li>it is the formation of an artificial opening in the large or small bowel left or right to divert the feces to the exterior where they are collected in a disposable, adhesive plastic bag. It could be temporary or permanent </li></ul><ul><li>R.P.M incision/more or less on mcburney’s point </li></ul><ul><li>No drain/ functioning on 2-4 days </li></ul>
  16. 20. Operations on large intestine <ul><li>Caecostomy </li></ul><ul><li>Colostomy </li></ul><ul><li>Terminal colostomy </li></ul><ul><li>Loop colostomy/transverse </li></ul><ul><li>Defunctioning colostomy </li></ul><ul><li>Colectomy- right& left hemi colectomy </li></ul><ul><li>Causes –carcinoma,TB, crohn’s disease, meckel’s diverticulum& ulcerative colitis </li></ul><ul><li>Right /left P.M incision </li></ul><ul><li>Abdominal& pelvic drains-5 th day removal </li></ul>
  17. 22. Physiotherapy <ul><li>As per protocol </li></ul><ul><li>Follow day wise /session wise progression </li></ul><ul><li>Do routine pre op& post op assessment and training </li></ul><ul><li>Change the treatment plan &execution of exercises acc. to the need </li></ul><ul><li>Safety and don’ts are more valuable than do’s </li></ul><ul><li>Start exercises to the parts away from the incision site </li></ul>
  18. 23. Physiotherapy <ul><li>Common pre-op training </li></ul><ul><li>Post op assessment </li></ul><ul><li>Problems </li></ul><ul><li>1.increased production of mucus secretions </li></ul><ul><li>2.inhibited cough reflex due to pain & Ryle's tube </li></ul><ul><li>3.Tiredeness -anaemia-less RBC production </li></ul><ul><li>4.haemetemesis </li></ul><ul><li>5.DVT </li></ul><ul><li>6.Others </li></ul>
  19. 24. Treatment <ul><li>Chest pt-PD, positioning, humidification </li></ul><ul><li>Encourage cough reflex/cough support </li></ul><ul><li>Treat for short duration(20-30 min) </li></ul><ul><li>Arm/leg exs,bed elevation </li></ul><ul><li>Early mobilization-prop up in the evening or next day/bed mobility </li></ul><ul><li>Wound care-hygiene </li></ul><ul><li>Micturition /bowel care& training </li></ul><ul><li>Pain relief-TENS </li></ul><ul><li>Oral hygiene </li></ul><ul><li>Diet </li></ul><ul><li>Abdominal& trunk exs after 1-2 days in a progressive manner </li></ul><ul><li>Discharge depends on surgery may be 3-4 days to 10 -14 days/minor or major surgery with or without complications </li></ul>

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