Flashcards in Week 7 Deck (78)
What are the mechanical causes of bowel obstruction?
What are the other causes of bowel obstruction?
• Foreign bodies
• Fecal impaction
What is a post-op ileus, which may also result in bowel obstruction?
A paralytic ileus, that is marked by dissociation of bowel motility. This commonly follows a spinal surgery, traumatic injury, or some LE joint reconstruction, but can also occur following minor orthopedic procedures
What may cause a post-op ileus that may result in bowel obstruction?
• Use of opioid medications which slows bowel motility
• Inactivity after a surgery or recovery from anesthesia
What are the consequences of a post op ileus?
• Abdominal pain
• More prolonged hospital stay
• Readmission to the hospital after being released
• Bowel perforation
What are the symptoms of a post op ileus?
Abdominal distention and discomfort
What is the ogilvie syndrome?
A syndrome that occurs after orthopedic structures, that tends to affect specific population such as an elderly nursing home resident that has been admitted for a hip fx. Their medication is the usual cause
Ogilvie syndrome is a functional bowel obstruction and it consist of massive dilation of...?
Massive dilation of the cecum and the ascending colon
What is an ogilvie syndrome as a result of?
An autonomic dysfunction and the inhibition of the parasympathetic activity on the colonic motor function, and if left untreated, can result in toxic megacolon, which can lead to ischemia and bowel wall thinning, colonic perforation, intra-abdominal sepsis and death
True or False
Bowel obstruction can be partial or complete
True, Bowel obstruction can be partial or complete
True or False
Suspicion of bowel obstruction requires hospitalization
True, Suspicion of bowel obstruction requires hospitalization
What are the interventions for a bowel obstruction?
• Nasogastric (NG) suction
• IV Fluids (inc. TPN, electrolyte replacement)
• Antibiotics if bowel ischemia suspected, before any surgery
• Surgery if needed, which includes a resection or possible colostomy
What should guide the use of electrolyte replacement as an intervention for bowel obstruction?
The test results, but if the pt is repeatedly vomiting, they are going to be low on serum sodium and potassium
What should be done if a pt's exam/CT scan suggests a strangulation of the bowel, what should be done?
An operative intervention
What should be done if a pt's exam/CT scan suggests no strangulation of the bowel, what should be done?
The non-operative interventions may be used
What does the type of bowel resection/partial colectomy performed on a pt with a bowel obstruction depend on?
The condition, location, a size of the diseased/damaged valve.
Why would a surgeon chose to perform a colectomy for a patient with bowel obstruction?
If the bowel needs to have rest for healing or if they can not determine a functioning bowel exit. This may be (temporary or permanent)
An open right hemicolectomy is another way to treat a bowel obstruction. What does this procedure involve?
It involves removing the cecum, the ascending colon, the hepatic flexure where the ascending colon joins the transverse colon
___ is the standard treatment for any malignant neoplasm of the R colon
*Open right hemicolectomy* is the standard treatment for any malignant neoplasm of the R colon
When is a pt at risk for a bowel obstruction?
• S/p abdominal surgeries
• S/p most any surgery where mobility is decreased
• Patients on opioid pain meds
At what point does a PT come in contact with a pt with a bowel obstruction?
At any point in their continuum of care or in any setting
Why would a pt with a bowel obstruction be treated in a post-acute facility/setting?
• Delayed mobility recovery s/p surgery
• Impaired functional status from illness, nutritional deficiencies, deconditioning
What are the PT Interventions for at risk individuals and those
admitted w/bowel obstruction signs and symptoms?
• Techniques for abdominal protection( mobility techniques like log rolling or wear an abdominal binder)
• Core abdominal strengthening
• Deep breathing techniques, cough instruction , and postural education
What are one of the big risk as a result of an abdominal surgery?
↑ risk of adhesion formation
What is the PT intervention for a pt with a stomach adhesion s/p an abdominal surgery?
Manual therapy, used for the prevention/treatment of a stomach adhesion. Called the clear passage approach.
What are the PT interventions that we use with pts s/p any surgery or illness causing immobility or use of medications that slow intestinal motility; those dx with bowel obstruction (non-surgical)?
• EARLY mobility protocols s/p surgery
• General effects of exercise and ambulation on intestinal motility and constipation
What are the PT Interventions for a pt s/p bowel resection
Enhanced Recovery After Surgery (ERAS) protocol which includes:
• Pre-operative optimization & screening(not usually done by the PT)
• Early mobilization for post-op, no specifics on type of exercise, just MOVE!
What are the complications of prolonged bedrest post surgery?
• Skeletal muscle atrophy and weakness
• Bone loss
• Decreased insulin sensitivity(can be detected after 3 days of bedrest)
• Thromboembolytic disease
• Macrovascular dysfunction
• Pressure ulcers
What are the symptoms post-op fatigue?
• Lack of concentration
• Increased exercise induced HR
• Elevated production of proinflammatory cytokines
• Decrease in cardiorespiratory effort
• Weight loss
• Muscle weakness