Week 8 - General surgery

Question 1

oesophagectomy - physio implications

Answer 1

resp dysfunction - deflates 1 lung for access
wounds - abdomen/tx/neck
risk of aspiration
precautions on +ve pressure, suctioning
inter costal catheter
risk of anastomosis b/d with consequent resp compromise

Question 2

gastrectomy - physio implications

Answer 2

due to food directly entering small intestine - nausea, vomiting
diarrhoea, cramps
dumping syndrome - hypotension
due to low blood sugar - fatigue, weakness, sweating, tachycardia
confusion

Question 3

Whipples - physio implications

Answer 3

long time under GA
resp complications etc
may have dumping syndrome unless modified whipples
priority pt

Question 4

GA pulmonary implications

Answer 4

reduced FRC
cilia beat frequency
ventilatory drive
atelectasis
absorption atelectasis due to O2
drying of cilia due to gas
reduced sighing
hypoventilation
hypoxaemia
resp mm insufficiency

Question 5

plan for general surgery pts

Answer 5

1. educate
2. mobilise
3. optimise O2 therapy

Question 6

PPC signs

Answer 6

persistent bilateral infiltrates on xray
fever >38.3
white blood cell count >12x10^9
purulent tracheal secretions
sats <90% on RA on 2 consecutive days
altered BS on ausc different to pre op ax
yellow or green sputum diff to pre op ax
chest xray of collapse/consolidation

Question 7

risk factors for PPC

Answer 7

age >60
smoker
GA
length of anaesthesia >3hrs
post op admission to ICU
resp comorbidity
pre op dependence
malnutrition
emergency procedure
congestive heart failure
location of surgery
ASA class 2 or higher

Question 8

Pre operative assessment criteria

Answer 8

Check medical records
Physio respiratory Ax
Institute treatments as required i.e. ex. optimise VO2 max

Question 9

PPC definition

Answer 9

An identifiable disease or dysfunction that is clinically relevant and adversely affects the
clinical course