ABDOMINAL SURGERY
 

Abdominal surgery broadly covers surgical procedures that involve opening the abdomen. (Laprotomy).Laproscopy has been applied in both the diagnostic and therapeutic fields. The technique is usually performed under general anesthesia with a small incision being made to introduce a cannula to facilitate the insufflation of carbon dioxide or nitrous oxide into peritoneal cavity. A pneumoperitoneum is created so that the peritoneal cavity may also be visualized through a laproscope and video camera and picture is tranmitted onto a monitor.The main advantages of this technique are the resultant reduction in post operative pain, pulmonary complications and hospital length of stay, improved cosmesis and an earlier return to work.Incisional sites may vary according to the individual surgeon’s preferences although to the surgical area of intreset. Ideally, incisions are made along the lines of least tissue tension to enable prompt healing and a fine scar line.Absorbable sutures are preferable for stitching deeper layers while stronger sutures are appropriate around joints and over the abdominal wall.Areas with good blood supply tends to heal quickly. The abdominal and chest wound sutures generally need 7-10 days prior to removal. 

 

Types of abdominal incisions 

 

 

 

 

 

 

 

 

 

 

 

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IMPAIRMENTS
 

Body Structures

1. Break in continuity of skin

2. Muscle atrophy

3. Retraction of muscles

4. Cut at free nerve endings

5. Retraction/Incision of peritoneum

6. Organ subject to surgery

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Body Functions

1. Pain

2. Tenderness

3. Generalized weakness

4. Reduced abdominal strength

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GOALS

 

• Short Term

1. Patient and family education

2. Ergonomic advice

3. Reduce pain

4. Reduce swelling

5. Increase abdominal strength

6. Maintain adequate ventilation

7. Prevent bed sores

8. Reduce use of accessory muscles of respiration

9. Removal of bronchial secretions

10. Bed mobility and ambulation

11. Correction of posture secondary to incisions or tubes

12. Appropriate oxygen tharapy and humidification

13. Achieve functional activities

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Long Term

1. Maintain all short term goals

2. Maintain range of motion

3. Prevent respiratory complications

4. Scar care

5. Improve quality of life

6. Maintain cardiovascular conditioning

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MANAGEMENT

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Pre Operative

1. Establish the patient’s exercise tolerance and undertake a general examination of musculoskeletal system. Examination of chest.

2. Patient education prior to surgery regarding the effects of surgery on respiratory function, the location of the wound, drips and drains may help to reduce pain,

3. Maximise pulmonary function

4. Use of adjuncts such as periodic continuous positive airway pressure(PCPAP) which helps if major respiratory problems are anticipated post operatively.

5. Intermittent positive pressure breathing(IPPB)

6. Advice the patient on cessation of smoking and wt reduction, ideally given weeks or months prior to admission.

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Post Operative

Patient and family education

• on scar care 

• on preventing complications

• How to get in and out of bed without putting undue strain on abdominal wound

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Reduce pain and swelling

• Cryotherapy for 10 -15 mins for 7-10 days

• Conventional TENS

• Effleurage massage technique for upper limb swelling

• Compression bandage for upper limb swelling

 

Early mobilization with assistance

• A graduated walking programme should be encouraged with the introduction of stair climbing at an appropriate stage.

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Prevent bed sores

• Bed mobility/positioning

  • Advice an optimum and regular change of position while the patient is in bed.

• Use of monkey poles, rope ladders and cot sides can reduce the patient’s reliance on staff.

• Suitable seating at a appropriate height to improve patient independence.

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Maintaining Respiratory System Integrity

• Thoracic expansion exercises

  • Deep breathing exercises i.e. Active inspiration combined with a 3 sec hold before the passive relaxed expiration.(Inappropriate in very breathless patients)

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• Incentive spirometry/Periodic continuous positive airway pressure/ Intermittent positive pressure breathing. – For immobile patients who are unable or ineffective in carrying out thoracic expansion exercises and are showing signs of unresolved atelactasis. 

 

Clearance of bronchial secretions

• advice on forced expiration technique and wound support , suction via the nasopharynx or oral airway once or twice may be an option. 

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Post Operative Complications

• Infection

• Decreased lung volume leading to atelectasis

• Pulmonary oedema

• Cardiovascular problems

• Injury to nerve

• Deep vein thrombosis

• Haemorrhage

• Nausea and vomiting

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REFERENCES

Jennifer A. Pryor , Barbara A. Webber, Physiotherapy for respiratory and cardiac problems, 2nd edition, pg no. 300- 322