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Physiotherapy in Physiotherapy in abdominal surgeryabdominal surgery

A.THANGAMANI RAMALINGAMA.THANGAMANI RAMALINGAM

PT, MSc(PSY),MIAPPT, MSc(PSY),MIAP

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Common Common operationsoperations

GastrectomyGastrectomy CholecystectomyCholecystectomy AppendecectomyAppendecectomy ColectomyColectomy ColostomyColostomy IleostomyIleostomy Herniotmy/ Herniorrhaphy/plastyHerniotmy/ Herniorrhaphy/plasty NephrectomyNephrectomy ProstatectomyProstatectomy CystectomyCystectomy MastectomyMastectomy HysterectomyHysterectomy

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GastrectomyGastrectomy

Removal of all or part of the stomachRemoval of all or part of the stomach gastrectomy was mostly used as a gastrectomy was mostly used as a

treatment for stomach/duodinal treatment for stomach/duodinal ulcers, however now this procedure ulcers, however now this procedure is used primarily for cancer of the is used primarily for cancer of the stomach stomach

Partial /total gastrectomy Partial /total gastrectomy

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CausesCauses

Peptic ulcer( gastric/duodenal)Peptic ulcer( gastric/duodenal) Pyloric stenosisPyloric stenosis Zollinger-ellison syndrome Zollinger-ellison syndrome

(hypergastrinaemia)(hypergastrinaemia) Malignancy (gastrinoma)Malignancy (gastrinoma)

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OperationsOperations VagotomyVagotomy PyloroplastyPyloroplasty GastrojeunostomyGastrojeunostomy Antrectomy (1/3 of stomach excised)Antrectomy (1/3 of stomach excised) Partial gastrectomy(2/3 of distal stomach excised)Partial gastrectomy(2/3 of distal stomach excised) Total gastrectomyTotal gastrectomy Billroth I –gastro-duodenal anastomosis-gastric Billroth I –gastro-duodenal anastomosis-gastric

ulcerulcer Polya operation-gastro-jejunal anastomosis-Polya operation-gastro-jejunal anastomosis-

duodenal ulcerduodenal ulcer Sleeve gastrectomySleeve gastrectomy

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77

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Nasogastric tube in situ (two hourly Nasogastric tube in situ (two hourly suction)suction)

33rdrd day liquid diet day liquid diet 55thth or 6 or 6thth day normal diet day normal diet

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complicationscomplications

Resp/circulatory/electrolyte imbalanceResp/circulatory/electrolyte imbalance early complications (with in a year)early complications (with in a year) paralytic ileus, stomal obstruction, paralytic ileus, stomal obstruction,

duodenal blow out, post dumping duodenal blow out, post dumping syndromes, pancreatitis, vomitingsyndromes, pancreatitis, vomiting

Late complicationsLate complications recurrent ulcer, fistula, nutritional recurrent ulcer, fistula, nutritional

deficiency, intestinal deficiency, intestinal obstruction,TB,gallstonesobstruction,TB,gallstones

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Post-operative carePost-operative care

– Depending on the severity of the Depending on the severity of the surgery, the patient may be sent to a surgery, the patient may be sent to a regular surgical room or may be sent to regular surgical room or may be sent to the surgical intensive care unit to be the surgical intensive care unit to be more closely monitoredmore closely monitored

– The nasogastric tube is left in place and The nasogastric tube is left in place and connected to suction to keep the connected to suction to keep the stomach empty. The tube is removed stomach empty. The tube is removed when stomach and bowel function when stomach and bowel function returns to normal, usually in 2 - 3 daysreturns to normal, usually in 2 - 3 days

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Fluids are given by vein (intravenously, I.V.)Fluids are given by vein (intravenously, I.V.)

Antibiotics are usually given I.V. for 24 hoursAntibiotics are usually given I.V. for 24 hours

Oxygen may be given by nasal catheterOxygen may be given by nasal catheter

Gradually the diet is increased from liquids to soft food Gradually the diet is increased from liquids to soft food and then more solid foods. A special diet may be necessary for and then more solid foods. A special diet may be necessary for many of the patients with a gastrectomymany of the patients with a gastrectomy

The wound is kept clean to prevent infection. Lotions The wound is kept clean to prevent infection. Lotions should not be applied to the woundshould not be applied to the wound

If radiation therapy or chemotherapy is given, there will If radiation therapy or chemotherapy is given, there will be follow up with a radiologist or oncologist.be follow up with a radiologist or oncologist.

Blood tests, CT scans and other diagnostic tests may be Blood tests, CT scans and other diagnostic tests may be necessary to follow the course of the diseasenecessary to follow the course of the disease

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PhysiotherapyPhysiotherapy

Common pre-op trainingCommon pre-op training Post op assessmentPost op assessment ProblemsProblems

1.increased production of mucus 1.increased production of mucus secretions of lower lobe of left lungsecretions of lower lobe of left lung

2.inhibited cough reflex due to pain & 2.inhibited cough reflex due to pain & ryle’s tuberyle’s tube

3.tiredeness-anaemia-less RBC production3.tiredeness-anaemia-less RBC production

4.haemetemesis4.haemetemesis

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TreatmentTreatment Chest ptChest pt Encourage cough reflexEncourage cough reflex Treat for short durationTreat for short duration Arm/leg exsArm/leg exs Early mobilization-prop up in the evening or next Early mobilization-prop up in the evening or next

dayday Wound careWound care Micturition /bowelMicturition /bowel Pain reliefPain relief Oral hygieneOral hygiene Diet Diet

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CholecystectomyCholecystectomy

the operation for removal of the gall the operation for removal of the gall bladderbladder

Laparoscopic CholecystectomyLaparoscopic Cholecystectomy

ERCP (Endoscopic Retrograde ERCP (Endoscopic Retrograde Cholangio-Pancreatography Cholangio-Pancreatography

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CausesCauses

Acute/chronic cholecystitisAcute/chronic cholecystitis CholelithiasisCholelithiasis Volvulus cholesterosisVolvulus cholesterosis carcinomacarcinoma

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OperationsOperations

Mini cholecystectomyMini cholecystectomy CholecystostomyCholecystostomy Extended with hepatic lobectomyExtended with hepatic lobectomy cholecystolithotomycholecystolithotomy

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Kocher’s incisionKocher’s incision Right upper paramedian incisionRight upper paramedian incision ‘‘T’ TUBE/cigarette drain/under water T’ TUBE/cigarette drain/under water

seal drain/corrugated rubber sheetseal drain/corrugated rubber sheet Duct-first/fundus first methodDuct-first/fundus first method

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ComplicationsComplications

Damage to bile duct/right hepatic Damage to bile duct/right hepatic artery/cystic arteryartery/cystic artery

Waltman-walter’s syndromeWaltman-walter’s syndrome

bile leakage,chest/abs painbile leakage,chest/abs pain

mimics pulmonary embolism/highly mimics pulmonary embolism/highly fatalfatal

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PhysiotherapyPhysiotherapy

ProblemsProblems

1.increased production of mucus 1.increased production of mucus secretions of lower lobe of right lungsecretions of lower lobe of right lung

PT as per protocolPT as per protocol