open abdominal surgery Flashcards
definition of laparotomy
an incision to allow access to the abdo cavity,
all abdo organs are examined in order to make a diagnosis and then procede to treatment
indications for a laparotomy
organ rupture - spleen, aorta, extopic pregnancy
- shock is a leading sign
- may be abdo swelling
- history of trauma
- blunt trauma -> spleen (may be weeks after)
- penetrating trauma -> liver
- peritonism might be mild
peritonitis
- perdo of ulcerm diverticulum, appendix, bowel or gallbladder
- signs - prostration, shock, lying still, +ve cough test, tenderness (+- rebound/percussion pain), board like abdo rigidity, guarding, absent bowel sounds
- erect CXR - air under diaphragm
syndromes that might not require a laparotomy
local peritonitis
- diverticulitis, cholecystitis, salpingitis, appendicitis
- if abscess suspected (swelling, swinging fever, high WCC) - US/CT - drainage can be percutaneous or laparotomy
- peritoneal inflammation can cause localised ileus with sentinal loop of intraluminal gas visible on plain AXR
colic
- regularly waxing and waning pain
- caused by muscular spasm in a hollow viscus - gut, ureter, salpinx, uterus, bile duct, or gallbladder
- causes restlessness
complications of laparotomy
wound may break down from a few days to weeks after op
risk in elderly, malnourished (cancer, IBD), if infection, uraemia or haematoma is present or in repeat laparotomies
warning sign is a pink serous discharge
wound dihiscence may lead to a burst abdo - with evisceration of the bowel
incisional hernia is a common late problem - repairable by mesh insertion (if necessary)
adhesions - can cause intestinal obstruction
