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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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AppendicectomyAppendicectomy

The appendix is a small finger-like projection that The appendix is a small finger-like projection that comes off the cecum of the large intestine and comes off the cecum of the large intestine and has no apparent function in the human. When the has no apparent function in the human. When the opening in the sac is blocked, it leads to an opening in the sac is blocked, it leads to an inflammation of the appendix called inflammation of the appendix called appendicitisappendicitis. This condition occurs most . This condition occurs most commonly in the young, between childhood and commonly in the young, between childhood and young adulthood. Appendicitis is an emergency young adulthood. Appendicitis is an emergency condition and requires urgent condition and requires urgent surgical removal surgical removal of the appendixof the appendix

Its position within the abdomen Its position within the abdomen corresponds to a point on the surface corresponds to a point on the surface known as known as McBurney'sMcBurney's point point..

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PositionsPositions Retrocecal or retro Retrocecal or retro

coliccolic Pelvic or Pelvic or

descendingdescending Sub cecalSub cecal Pre&post ilealPre&post ileal

IndicationsIndications Acute appendicitisAcute appendicitis Recurrent /chronicRecurrent /chronic Appendicular massAppendicular mass TumoursTumours GangreneGangrene PerforationPerforation peritonitisperitonitis

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IncisionIncision

Mcburney’s grid iron incisionMcburney’s grid iron incision Lanz’s transverse incision (cosmetic)Lanz’s transverse incision (cosmetic) Rutherford Morrison's muscle cutting Rutherford Morrison's muscle cutting

incisionincision laproscopylaproscopy

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Drains may or may not beDrains may or may not be Wait for intestinal peristalsis heard Wait for intestinal peristalsis heard

for diet for diet

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ComplicationsComplications Wound infectionWound infection Abdominal abscess due to spillage of Abdominal abscess due to spillage of

bacteria after a ruptured appendicitisbacteria after a ruptured appendicitis Bowel obstructionBowel obstruction Urinary tract infectionUrinary tract infection HemorrhageHemorrhage Injury to the large or small bowel, ovary or Injury to the large or small bowel, ovary or

other abdominal organs requiring removalother abdominal organs requiring removal Subphrenic or pelvic abcessSubphrenic or pelvic abcess Fecal fistula Fecal fistula

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HerniaHernia

A hernia is a protrusion of usually a loop of A hernia is a protrusion of usually a loop of bowel or a tissue through an opening in bowel or a tissue through an opening in the wall of the abdominal cavity in which the wall of the abdominal cavity in which the bowel lies. Hernias are one of the most the bowel lies. Hernias are one of the most common conditions requiring surgery. common conditions requiring surgery.

Hernias can develop around the navel, in Hernias can develop around the navel, in the groin, or any place where you may the groin, or any place where you may have had a surgical incision. Some hernias have had a surgical incision. Some hernias are present at birth. are present at birth.

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Types of HerniaTypes of Hernia

Inguinal hernia Inguinal hernia Femoral hernia Femoral hernia Umbilical hernia Umbilical hernia Incisional herniaIncisional hernia Epigastric herniaEpigastric hernia Hiatus herniaHiatus hernia Strangulated hernia Strangulated hernia

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Surgical RepairSurgical Repair

HerniotomyHerniotomy HerniorrhapyHerniorrhapy Hernioplasty Hernioplasty Laparoscopic Laparoscopic

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ComplicationsComplications Chronic pain may result from surgical handling of Chronic pain may result from surgical handling of

the sensory nerve in the groin area during the sensory nerve in the groin area during surgery, or after surgery from constricting scar surgery, or after surgery from constricting scar tissuetissue

InfectionInfection HemorrhageHemorrhage Ischemic orchitis due to thrombosis of the Ischemic orchitis due to thrombosis of the

spermatic cord and venous congestion produces spermatic cord and venous congestion produces pain and swellingpain and swelling

Recurrence of the hernia due to excessive tension Recurrence of the hernia due to excessive tension during repair, inadequate tissue, inadequate during repair, inadequate tissue, inadequate repair, and overlooked hernias. Recurrence rates repair, and overlooked hernias. Recurrence rates are 1-4%are 1-4%

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NephrectomyNephrectomy

Removal of the kidneyRemoval of the kidney Approaches Approaches

- Lumbar approach (common) –- Lumbar approach (common) –oblique from 12 th rib angle to ASISoblique from 12 th rib angle to ASIS

-Through the 12 th rib-Through the 12 th rib

-Nagamatsu incision(hockey stick -Nagamatsu incision(hockey stick fashion)-12fashion)-12thth rib removed ,extends upto rib removed ,extends upto 1010thth rib rib

-Trans peritoneal approach -Trans peritoneal approach

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IndicationsIndications

Renal tumorsRenal tumors TBTB Hydro nephrosisHydro nephrosis CalculiCalculi HTNHTN HemorrhageHemorrhage Pyogenic infectionPyogenic infection

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ComplicationsComplications

Complications of any surgery such as heart attack, heart Complications of any surgery such as heart attack, heart failure, stroke, pneumonia, blood clots in the legs and failure, stroke, pneumonia, blood clots in the legs and pulmonary embolism (blood clot to the lungs)pulmonary embolism (blood clot to the lungs)

Injury to the stomach, small bowel or large bowelInjury to the stomach, small bowel or large bowel Tears of the liverTears of the liver Injury to the spleenInjury to the spleen Injury to the pancreas with pancreatitisInjury to the pancreas with pancreatitis Bowel obstruction may occurBowel obstruction may occur Ileus (temporary loss of bowel function)Ileus (temporary loss of bowel function) Hemorrhage which may be severeHemorrhage which may be severe Pneumothorax (puncture of the lung)Pneumothorax (puncture of the lung) InfectionInfection Temporary loss of renal function of the other kidneyTemporary loss of renal function of the other kidney Incisional hernia Incisional hernia 

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ChemotherapyChemotherapy Radiation therapy Radiation therapy Immunotherapy Immunotherapy

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Operations on small Operations on small intestineintestine

EnterotomyEnterotomy EnterectomyEnterectomy End to end anastomosisEnd to end anastomosis Side to side anastomosisSide to side anastomosis Oblique anastomosis Oblique anastomosis End to side anastomosisEnd to side anastomosis

Enterostomy- jejunostomy / ileostomy Enterostomy- jejunostomy / ileostomy

IleostomyIleostomy it is the formation of an artificial opening in the large or small it is the formation of an artificial opening in the large or small

bowel left or right to divert the feces to the exterior where they bowel left or right to divert the feces to the exterior where they are collected in a disposable, adhesive plastic bag. It could be are collected in a disposable, adhesive plastic bag. It could be temporary or permanenttemporary or permanent

R.P.M incision/more or less on mcburney’s pointR.P.M incision/more or less on mcburney’s point No drain/ functioning on 2-4 daysNo drain/ functioning on 2-4 days

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Operations on large Operations on large intestineintestine

Caecostomy Caecostomy ColostomyColostomy Terminal colostomyTerminal colostomy Loop colostomy/transverseLoop colostomy/transverse Defunctioning colostomyDefunctioning colostomy Colectomy- right& left hemi colectomyColectomy- right& left hemi colectomy

Causes –carcinoma,TB, crohn’s disease, meckel’s Causes –carcinoma,TB, crohn’s disease, meckel’s diverticulum& ulcerative colitisdiverticulum& ulcerative colitis

Right /left P.M incisionRight /left P.M incision Abdominal& pelvic drains-5Abdominal& pelvic drains-5thth day removal day removal

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Physiotherapy Physiotherapy As per protocolAs per protocol Follow day wise /session wise progressionFollow day wise /session wise progression Do routine pre op& post op assessment and Do routine pre op& post op assessment and

trainingtraining Change the treatment plan &execution of Change the treatment plan &execution of

exercises acc. to the needexercises acc. to the need Safety and don’ts are more valuable than Safety and don’ts are more valuable than

do’sdo’s Start exercises to the parts away from the Start exercises to the parts away from the

incision siteincision site

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PhysiotherapyPhysiotherapy Common pre-op trainingCommon pre-op training Post op assessmentPost op assessment ProblemsProblems 1.increased production of mucus secretions1.increased production of mucus secretions 2.inhibited cough reflex due to pain & Ryle's 2.inhibited cough reflex due to pain & Ryle's

tubetube 3.Tiredeness -anaemia-less RBC production3.Tiredeness -anaemia-less RBC production 4.haemetemesis4.haemetemesis 5.DVT5.DVT 6.Others 6.Others

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TreatmentTreatment Chest pt-PD, positioning, humidificationChest pt-PD, positioning, humidification Encourage cough reflex/cough supportEncourage cough reflex/cough support Treat for short duration(20-30 min)Treat for short duration(20-30 min) Arm/leg exs,bed elevationArm/leg exs,bed elevation Early mobilization-prop up in the evening or next day/bed Early mobilization-prop up in the evening or next day/bed

mobilitymobility Wound care-hygieneWound care-hygiene Micturition /bowel care& trainingMicturition /bowel care& training Pain relief-TENSPain relief-TENS Oral hygieneOral hygiene Diet Diet Abdominal& trunk exs after 1-2 days in a progressive Abdominal& trunk exs after 1-2 days in a progressive

mannermanner Discharge depends on surgery may be 3-4 days to 10 -14 Discharge depends on surgery may be 3-4 days to 10 -14

days/minor or major surgery with or without complicationsdays/minor or major surgery with or without complications