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
What large intestinal surgery may be carried out?
Intestinal biopsy
Colectomy
What rectal/anal surgery may be carried out?
Rectal polyps/tumours Rectal prolapse Imperforate anus Anal sac removal Anal furunculosis
What nursing considerations should we have for GI surgery patients?
Feeding tubes Nutrition - softened, bland, low-fat Treatment of dehydration/hypovolaemia - IVFT Monitor for arrhythmias in GDV Moist abdominal contents during surgery Label biopsy samples with site Pre-op antibiotics in large intestinal surgery Positioning during surgery Protect prolapses prior to surgery
Describe peritonitis.
Contamination/irritation of lining of abdominal cavity, leading to inflammatory response
Life-threatening
Infection leads to severe illness, sepsis, shock and cardiovascular collapse
Prognosis is guarded
What are the clinical signs of peritonitis?
Pyrexia / Anorexia Depression Tachycardia Vomiting Ascites Abdominal pain
How do we treat peritonitis?
Surgical exploration of abdomen to find source of contamination
Thorough lavage of abdomen
Infection managed with open peritoneal drainage (sterile dressings)
Intensive nursing - IVFT, close monitoring of blood albumin/electrolytes, hydration, bandage care
