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Pt in gastrectomy& cholecystectomy

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pre& post operative physiotherapy protocol .

pre& post operative physiotherapy protocol .

Published in: Education, Health & Medicine
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  • 1. Physiotherapy in abdominal surgery A.THANGAMANI RAMALINGAM PT, MSc(PSY),MIAP
  • 2. Common operations
    • Gastrectomy
    • Cholecystectomy
    • Appendecectomy
    • Colectomy
    • Colostomy
    • Ileostomy
    • Herniotmy/ Herniorrhaphy/plasty
    • Nephrectomy
    • Prostatectomy
    • Cystectomy
    • Mastectomy
    • Hysterectomy
  • 3. Gastrectomy
    • Removal of all or part of the stomach
    • gastrectomy was mostly used as a treatment for stomach/duodinal ulcers, however now this procedure is used primarily for cancer of the stomach
    • Partial /total gastrectomy
  • 4. Causes
    • Peptic ulcer( gastric/duodenal)
    • Pyloric stenosis
    • Zollinger-ellison syndrome (hypergastrinaemia)
    • Malignancy (gastrinoma)
  • 5. Operations
    • Vagotomy
    • Pyloroplasty
    • Gastrojeunostomy
    • Antrectomy (1/3 of stomach excised)
    • Partial gastrectomy(2/3 of distal stomach excised)
    • Total gastrectomy
    • Billroth I –gastro-duodenal anastomosis-gastric ulcer
    • Polya operation-gastro-jejunal anastomosis-duodenal ulcer
    • Sleeve gastrectomy
  • 6.  
  • 7.  
  • 8.
    • Nasogastric tube in situ (two hourly suction)
    • 3 rd day liquid diet
    • 5 th or 6 th day normal diet
  • 9. complications
    • Resp/circulatory/electrolyte imbalance
    • early complications (with in a year)
    • paralytic ileus, stomal obstruction, duodenal blow out, post dumping syndromes, pancreatitis, vomiting
    • Late complications
    • recurrent ulcer, fistula, nutritional deficiency, intestinal obstruction,TB,gallstones
  • 10. Post-operative care
      • Depending on the severity of the surgery, the patient may be sent to a regular surgical room or may be sent to the surgical intensive care unit to be more closely monitored
      • The nasogastric tube is left in place and connected to suction to keep the stomach empty. The tube is removed when stomach and bowel function returns to normal, usually in 2 - 3 days
  • 11.
    • Fluids are given by vein (intravenously, I.V.)
    • Antibiotics are usually given I.V. for 24 hours
    • Oxygen may be given by nasal catheter
    • Gradually the diet is increased from liquids to soft food and then more solid foods. A special diet may be necessary for many of the patients with a gastrectomy
    • The wound is kept clean to prevent infection. Lotions should not be applied to the wound
    • If radiation therapy or chemotherapy is given, there will be follow up with a radiologist or oncologist.
    • Blood tests, CT scans and other diagnostic tests may be necessary to follow the course of the disease
  • 12. Physiotherapy
    • Common pre-op training
    • Post op assessment
    • Problems
    • 1.increased production of mucus secretions of lower lobe of left lung
    • 2.inhibited cough reflex due to pain & ryle’s tube
    • 3.tiredeness-anaemia-less RBC production
    • 4.haemetemesis
  • 13. Treatment
    • Chest pt
    • Encourage cough reflex
    • Treat for short duration
    • Arm/leg exs
    • Early mobilization-prop up in the evening or next day
    • Wound care
    • Micturition /bowel
    • Pain relief
    • Oral hygiene
    • Diet
  • 14. Cholecystectomy
    • the operation for removal of the gall bladder
    • Laparoscopic Cholecystectomy
    • ERCP (Endoscopic Retrograde Cholangio-Pancreatography
  • 15. Causes
    • Acute/chronic cholecystitis
    • Cholelithiasis
    • Volvulus cholesterosis
    • carcinoma
  • 16. Operations
    • Mini cholecystectomy
    • Cholecystostomy
    • Extended with hepatic lobectomy
    • cholecystolithotomy
  • 17.
    • Kocher’s incision
    • Right upper paramedian incision
    • ‘ T’ TUBE/cigarette drain/under water seal drain/corrugated rubber sheet
    • Duct-first/fundus first method
  • 18. Complications
    • Damage to bile duct/right hepatic artery/cystic artery
    • Waltman-walter’s syndrome
    • bile leakage,chest/abs pain
    • mimics pulmonary embolism/highly fatal
  • 19. Physiotherapy
    • Problems
    • 1.increased production of mucus secretions of lower lobe of right lung
    • PT as per protocol

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