General Surgery Flashcards
ectomy
removal of
oplasty
reconstruct
ostomy
make an opening
otomy
cut into
scopy
examine using a scope
Components of General Surgery
one or more components of the GI system oesophagus stomach small and large intestine pancreas liver gall bladder bile ducts thyroid appendix rectum and anus
Indicators General Surgery
cancer hernia inflammation intestinal perferations infection obesity reflux disease trauma
LAPAROSCOPY
‘keyhole surgery’
camera and surgical equipment inserted via three small insertions
distend abdomen by injecting CO2, moves organs out of the way
can be used for many procedures
reduced risk of PPCs afterwards
OESOPHAGECTOMY
removal of all or part of the oesophagus
Indications - cancer, Barrett’s oesophagus, trauma
normally via and open procedure
oesophagus removed and then stomach reattached in new location
Considerations
- during surgery right lung completely deflated, possible single lung ventilation post surgery
- breathing dysfunctions due to abdominal and thoracic wounds
- risk of anastomical breakdown resulting in respiratory compromise
- risk of aspiration
- positive pressure devices can cause oesophageal trauma
TOTAL GASTRECTOMY
total removal of the stomach
Indications - cancer, preventative, bleeding ulcers, perforation
Considerations -
- food now enters small intestine - will have vomiting, cramping, nausea, diarrhoea
- rapid increase and decrease in blood sugar levels
Dumping Syndrome - water pulled into small intestine in order to aid digestion, causes sudden drop in blood pressure
PARTIAL/SLEEVE GASTRECTOMY
Partial - removal of lower half of the stomach
Sleeve - removal of left half of the stomach
- usually done via laparoscopy
Considerations -
- nutritional deficiencies
- blood sugar fluctuations
WHIPPLE PROCEDURE
‘pancreaticoduodenectomy’
- removal of pancreas, duodenum, gall bladder, distal common bile duct, small portion of stomach and some lymph nodes
COLECTOMY
removal of all or part of the colon
Indications - colorectal cancer, Crohn’s disease, ulcerative colitis, diverticulitus
Potentially will have a colostomy afterwards - colon out of abdomen, faeces collects in bag automatically
Physio Considerations
- emptying into bag will increase with exercise, patient unable to control this
- ensure new bag before start treatment
ABDOMINAL PERINEAL RESECTION
excision of sigmoid colon, rectum and anus
forms a permanent colostomy
Pulmonary Implications Post General Surgery - impact GA
Decreased ventilatory drive
- decreased TV, RR and minute ventilation
- positive pressure from ventilator during surgery forces air to non-dependent lung areas
- hypoventilation and lack of sigh = higher closing capacity
Atelactasis
- reduced ventilatory drive causes reduced FRC
- supine positioning reduces FRC
- may have absorption atelactasis due to increased oxygen
- overall reduced lung volumes
Impaired Mucociliary Clearance
- gas dries the airways and cilia
- drugs reduced ability of the cilia to beat
Loss of Respiratory Muscle Tone
- pain
- phrenic nerve inhibition
- paralysing agents
Hypoxaemia - decreased chemoreceptor sensitivity from drugs
Respiratory depression
respiratory muscle dysfunction
reduced FRC due to supine and anaesthesia
reduced MCC
imparied cough and gag reflex
lack of sigh causes reduced surfactant production = reduced complaince
patient reduced LOC
Progressive Cephaloid Displacement of the Diaphragm
- supine - diaphragm moves upwards
anaesthesia - worsens movement of the diaphragm upwards
further worsened by gas insufflation into the abdomen
movement of diaphragm = reduced FRC
