Gastrointestinal Surgery Flashcards
Define -otomy.
Cutting open/dividing tissue during surgery, after which it is repaired and allowed to heal normally.
Define -ostomy.
Creation of an opening/stoma which communicates with outside through the skin. Device used to keep open until allowed to close, or permanent stoma sutured to skin and allowed to heal open.
Define -oscopy.
Use of device/instrument to give visual access inside a cavity.
Define -ectomy.
Surgical removal of all/part of a structure
Where only part removed, remaining part must be sutured back together (anastomosis)
How do we care for GI surgery patients pre-op?
Often emergency and very unwell patients
Fluid/electrolyte deficits identified and stabilised prior to anaesthesia/surgery
Consider IV fluids/placement of feeding tube for post-op management
In some cases e.g. GDV, initial stabilisation is an emergency
How do we prep a GI patient for surgery?
Pre-op starving (12hrs not possible if emergency)
Check with surgeon if enema wanted
Antibiotics - usually intra-/post-op, not pre-op
Specific management e.g. passing a stomach tube in GDV
How do we surgically prepare a GI patient?
Oral surgery = flush mouth with saline
Ventral midline laparotomy = aseptic prep of wide area, above xiphoid to below pubis
Anal/rectal surgery = specific positioning (e.g. sternal with tail tied up), may require packing and/or purse-string suture
What other intra-op considerations should we have for GI patients?
Warmth - often long ops with open abdomen, plan temp. regulation and warming
ET tube seal - high risk of regurgitation, may tilt patient slightly with head lowered to allow drainage
What instruments/equipment do we need for GI surgery?
Laparotomy swabs Suction Histopathology pot (biopsy samples) Specific instruments e.g. gelpis/atraumtic bowel clamps Two kits/gloves/drapes - surgeon may need to change contaminated kit mid-surgery Pre-warmed saline Stomach tube and bucket Endoscope - depends on procedure
What is the VN’s role in GI surgery?
May scrub in to clamp intestines with fingers
Keep exposed GI contents moist - warm saline trickled over tissues
Keep contaminated instruments separate
Control suction machine
Have additional swabs/instruments to hand, take biopsy samples from surgeon
What oral surgery might be carried out?
Oral tumours
Oro-nasal fistulae
Clef palate
Foreign bodies/penetrating injuries
What oesophageal surgery might be carried out?
Oesophageal foreign bodies
Oesophageal stricture
What gastric surgery might be carried out?
Foreign body Pyloric obstruction Gastric neoplasia Gastric dilatation-volvulus (GDV) Tube gastrotomy
What is the treatment plan for GDV?
Treat shock - rapid admin of fluids
IV antibiotics
Decompression of stomach by passing stomach tube
Right lateral radiograph taken to confirm volvulus
ECG - check for ventricular dysrhythmias
Surgery to decompress/de-rotate stomach, gastropexy may be performed
What small intestinal surgery may be carried out?
Intestinal biopsy Enterotomy (foreign body removal) Enterectomy Intussusception Neoplasia
