Manual Browses Introduction to the Investigation and Management of Surgical Disease

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Buy securely. Book of the Month. This can be monitored using auscultation to determine where the secretions are broad. Blood pressure can help determine cardiovascular status of the patient [13]. Other observations could be heart rate, respiratory rate and temperature as these can all be altered if the patient has an infection [12].

Pre-operative Physiotherapy [11]. Trying to see a patient before surgery can be beneficial, however, it can also be difficult if its an emergency or could be due to time constrictions with the patients, particularly within the NHS. The main problems found on assessment of a patient who has had major surgical procedure is reduced lung volume [11].

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This could result in impaired gas exchange and airway clearance [11]. Other cardiovascular and respiratory effects are reduction in functional residual capacity, PaO2, VO2Max, cardiac output and stroke volume, and an increase in HR [11]. Thus the aim of the physiotherapist is to try and improve these problems.

From the post-operative assessment a treatment plan will be developed.


If their pain can be managed, this may result in a reduced length of stay in the hospital, reduce their length of rehabilitation and their rehabilitation will be more efficient [11]. Pain can be reduced through medication, education, careful handling and relaxation techniques [12]. The main concerns after surgery are the risks of post-operative pulmonary complications and these can all be prevented if pain is managed and the patient is mobile.

However, other risk factors are associated with the risk of post-operative pulmonary complications [5] :. The content on or accessible through Physiopedia is for informational purposes only. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more. Search Search. Toggle navigation p Physiopedia. Another risk is CE retention, which occurs in up to 1. Hansel, M. The yield of CE is dependent upon timing of the test relative to the bleeding episode.

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The highest likelihood of detecting treatable SB lesions is when CE is performed within 72 hours of bleeding. The yield significantly declines two weeks after the bleeding episode. Multiphase CT enterography CTE has a higher sensitivity than capsule endoscopy for the detection of small bowel tumors. The administration of a large volume of neutral or negative oral contrast allows adequate SB distension and evaluation of mucosal details, while IV contrast allows optimal visualization of the mesenteric vasculature.

CT angiography CTA without oral contrast is recommended for urgent imaging in patients with active bleeding, especially those with hemodynamic instability. With its rapid imaging capabilities and higher accuracy, CTA has largely replaced the technetium 99m red blood cell scan. Multiphase CT imaging is contraindicated in patients with decreased renal function and IV contrast allergy.

Long-term patient outcomes associated with SB bleeding, especially after endoscopic treatment of vascular lesions, are still unknown. Although the recurrence rate of SB bleeding is high, endoscopic treatment typically reduces transfusion requirements.