Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Pt in gastrectomy& cholecystectomy


Published on

pre& post operative physiotherapy protocol .

Published in: Education, Health & Medicine
  • Be the first to comment

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>