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Pt in gastrectomy& cholecystectomy

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pre& post operative physiotherapy protocol .

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Pt in gastrectomy& cholecystectomy

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

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