Cholecystectomy ?Removal of the gallbladder ?Reasons: gallstones, inflammation (to restore flow of bile from liver to the small intestine) ?Preoperative: enema, NPO ?Open: insertion of T tube for bile, nasogastric tube, possible JP, 4 days ?Laparoscopic: 3-4 puncture wounds in abdomen, incision below umbilicus, 1 day ?
Postoperative: pain medication ?Diet: frequent small meals of high carb, high protein, low fat foods; avoid alcohol (laparoscopic patients may have fluids the night of surgery) ?Complications: hemorrhage, shock, paralytic ileus, peritonitis, electrolyte imbalance, wound infection, pulmonary problems, Postcholecystectomy syndrome (right upper quadrant pain, flatulence, fatty food intolerance) ?
Complications from laparoscopy: bleeding, wound infection, abdominal cramps and shoulder pain, sepsis, biliary peritonitis, strictures ?Activity: Laparoscopic: ^ mobility to v gas and abdominal distention, avoid heavy lifting/strenuous work for 1 week; Open: avoid heavy lifting/strenuous work for 4-6 weeks, gradual ^ in activity and allow for maximum rest Colonoscopy ?Examine lower large intestine (colon) ?Reasons: change in bowel habits, rectal bleeding, diverticulosis, polyps, Ulcerative colitis, Crohn’s,
IBS, benign tumors, anorectal fistulae, screen for colon cancer ?Colonoscope to view lining of colon (can obtain tissue biopsies and remove polyps), outpatient ?Preoperative: 1 week prior: avoid taking NSAIDS to avoid bleeding risk, avoid bulk-forming agents (Metamucil) or iron-containing preps (obstruct view of bowel); 48hr prior: clear liquid diet; 8hr prior: laxative, NPO ?Postoperative: gas with abdominal distention is common; light rectal bleeding is common if biopsies were taken ?Diet: can resume normal diet once home ?
Activity: avoid vigorous activity on the day of the procedure but then may resume activities as tolerated (need to remove gas) Sigmoidoscopy ?Examine and biopsy lesions of sigmoid colon, rectum, anal canal ?Reasons: same as colonospopy but screen for rectal cancer ?Sigmoidoscope to view lining of rectum ?Preoperative: enema day of surgery ?Postoperative: same as colonoscopy Abdominal Surgery ?
Preoperative: NPO, enema ?May have nasogastric tube until bowel sounds return, urethral catheter, drain (Hemovac, JP) ?Postoperative: turn, cough (must splint abdomen), deep breathe, incentive spirometer, ted hose, pain meds (patient-controlled), IV fluids, gas is common?
Complications: wound infection, wound dehiscence, DVT, thrombophlebitis, paralytic ileus, Dumping syndrome, fluid-electrolyte imbalance, UTI, pulmonary complications, hemorrhage, dehydration, anemia, shock, acute renal failure, bowel obstruction ?Activity: activity gradually as tolerated (v gas), frequent rest periods, avoidance of prolonged sitting or lying in bed, avoid heavy lifting/strenuous work for 4-6 weeks ?Diet: low in residue, high in protein and calories Appendectomy ?Appendectomy is a surgical removal of the appendix within 24 to 48 hours of onset of symptoms or when patient is stabilized. ?Laparoscopic if not ruptured (1 day)?
Open if ruptured: drain (5 days) ?Postoperative: may need to irrigate wound if appendix ruptured ?Activity: avoid heavy lifting/strenuous work for 4-6 weeks Gastrectomy is surgical removal of the entire stomach or a portion of the stomach with anastomosis to the small intestine.
Gastrostomy is a surgically constructed stoma (ostomy) in the stomach for the insertion of a catheter for tube feedings, decompression, or drainage Reasons: hemorrhage, intractable ulcers, esophageal disorders: carcinoma, stricture, atresia, trauma, dysphagia, perforation, gastritis, stomach cancer, severe dysphagia, such as caused by cerebrovascular accident requiring long-term gastric access for enteral nutrition Nasogastric tube, incisions, intravenous fluid and electrolyte therapy, and indwelling urethral catheter.
Postoperative: coughing, deep breathing, and splinting incision, incentive spirometer, discuss postoperative body changes (ostomy) Provide explanation of stoma or catheter care, the initiation of tube feedings, or diet modifications. Complications: dehydration, electrolyte imbalance, aspiration pneumonia, wound infection, anemia, gastric tube dislodgement, atelectasis, shock; hemorrhage; perforation or leakage of the anastamosis.