7/1/2016
1

Medical and surgical history and any lifestyle factors
(such as current medications, or history of smoking)
that may affect your operation

Explain the operation ,the possibility of further surgery
once the diagnosis is made

consent to the operation

Conduct tests like x-rays and blood tests

Shaving in the abdominal area.

Surgical scrub lotion to use in the shower and a
theatre gown to wear.

Given an enema or some other form of bowel
preparation to help empty your bowels.

An anesthetist will check that Patient is fit for the
operation and take note of any allergies

‘nil by mouth’ (nothing to eat) for a number of hours

Temperature, pulse, Respiration, Blood pressure and wound site are
carefully monitored.

Drain inserted at the wound site.

A small tube may been passed through nose and into your stomach to
help drain stomach secretions for a day or two.

This rests your digestive tract as it heals.

A urinary catheter may be inserted to drain off urine.

Intravenous fluids (directly into the vein), as you may not be allowed to
eat for a few days.

Pain relief Drugs
7/1/2016
8
It means removal of the vermiform appendix
1- Acute appendicitis (urgent or interval appedicectomy).
2- Recurrent attacks of subacute appendicitis.
3- Tumor of the appendix.
The most common incision used, is the gridiron (McBurney) or muscle
splinting incision. Other incisions are right lower paramedian incision
and lanz incision
1- Gridiron or (McBurney) incision:
The incision is an oblique one and runs in a downward
and inward direction in the line of the external oblique
muscle. It is about 5 cm in length, with its center at the
junction of the middle and lateral thirds of a line drawn from
the umbilicus to the right anterior superior iliac spine.
Muscles cut during this incision:
1- External oblique muscle.
2- Internal oblique muscle.
3- Transverse abdominis muscle
Advantages of gridiron incision:
1- Direct exposure of the appendix.
2- Can be extended.
3- Heals rapidly
Disadvantages of gridiron incision:
1- Not exploratory.
2- Its extension causes muscle damage.
3- May be followed by inguinal hernia.
2- Right lower paramedian incision:
Vertical incision that is situated 1.2-2.5 cm from the medline and below
the umbilicus
Advantages:
Exploratory.
Disadvantages:
1- Doubtful diagnosis.
2- Appendicitis with generalized peritonitis.
Muscle cut during this incision:
Rectus abdominis muscle
2- Right lower paramedian incision:
Vertical incision that is situated 1.2-2.5 cm from the medline and below
the umbilicus
Advantages:
Exploratory.
Disadvantages:
1- Doubtful diagnosis.
2- Appendicitis with generalized peritonitis.
Muscle cut during this incision:
Rectus abdominis muscle
Lanz incision (transverse lower abdominal skin crease incision):
Done in the interspinous crease, so cosmetically better as it passes with
langer's line
3-
:
•pain
•Delayed wound healing.
•Respiratory complications.
•Circulatory complications.
•Muscle weakness
Physical Therapy Role for appendiectomy
Primary aims
•To decrease the postoperative pain.
•To encourage and accelerate the healing process.
•To prevent post-operative respiratory complications.
•To prevent post-operative circulatory complications.
•To improve the abdominal muscles, particularly the oblique and transverse
groups.
Secondary aims:
•To maintain and improve the power of other trunk muscles.
Modalities of treatment:
1-TENS:
- Electrode placement: para incisional.
- pulse duration:
80µs.
- Pulse rate:
140 Hz.
- Amplitude and frequency of treatment: 60 min/4 hours.
2-Laser:
- Purpose of application: wound healing.
- Dosage: 90 sec/cm2.
- Distance from the skin: 2-3 mm.
-Mode: continuous mode
-Power: 1mW.
3- Pulmonary physical therapy:
Incentive spirometery training:
Method of application:
1- First method:
The patient should be instructed to exhale normally and then insert the
mouthpiece and take slow, deep inspiration. Occasionally, a nose clip may be necessary
if the patient has difficulty with proper inhalation technique.
2- Second method:
Is the inhalation hold method. The patient takes a maximal inhalation and
momentarily holds the inspiration for a count of 3 to 5 seconds. This technique helps
to ventilate airways that are collapsed distal to an obstruction such as mucous plug.
Frequency: 10 consecutive breaths/hour.
*Benefits:
•Prevention of atlectasis.
•Improve cough mechanism due to improved inspiratory capacity.
•Strengthening of the diaphragm.
4- Foot and leg exercises:
Simple foot, ankle and leg exercises are used during the early postoperative days to
accelerate the venous circulation through the lower limbs and pelvis. They are especially
important in the period before regular walking is allowed.
*It
includes the following exercises:
•
Lying: alternate ankle bending and stretching.
•
Lying: alternate foot turning inwards and outwards.
•
Lying: single foot circling.
•
Lying: single slight knee raising and lowering, followed by firm leg down pressing.
•
Lying: single and double quadriceps contractions.
•
Lying: combined quadriceps and gluteal contractions.
•
Sitting over edge of the bed: alternate ankle bending and stretching.
•
Sitting over edge of the bed: alternate leg swinging.
•
Sitting over edge of the bed: alternate knee stretching.
5- Abdominal muscle exercise:
- Duration of exercise: 20 min.
- Type of exercise: active exercise.
- Procedure:
1- lying: trunk turning with single arm carrying across the chest.
2-Crock lying: pelvis rising.
7/1/2016
18
It can be defined as it is a surgical excision of the breast.
(1) Radical mastectomy:
is a removal of the breast and entire system of lymphatic glands,
with excision of a part of pectoralis major and whole of pectoralis
minor muscles .
(2) Modified radical mastectomy:
is excision of the breast, and retraction of the pectoralis major
with or without removal of the pectoralis minor, the axilla is
maintained and there is no hollowing below the clavicle
1.Cancer breast.
2.Severe laceration of breast tissue
1.Presence of distant metastasis.
2.Proved supraclavicular metastasis.
3.Edema of arm.
4.Extensive edema of skin of breast.
1.Lymphodema: it may result from surgical procedure, irradiation
or uncontrolled progression of neoplasm.
2.Post mastectomy pain.
3.Pneumothorax: i.e. presence of air or gas in the pleural cavity, it
occurs with extended tissue dissection, the respiratory
dysfunction is associated with this surgery.
4.Restriction of shoulder ROM: it is usually associated with
axillary dissection or radiotherapy.
Evaluation
1. Goniometric Measurements:
By using a standard, plastic universal goniometer to obtain goniometric
measurements for shoulder flexion - extension -adduction abduction and
external & internal rotation
2. Upper extremity circumferential measurements at five levels:
The circumferential measurements were obtained by marking the most
prominent aspect of the olecranon process and then measuring and marking
points 7.5 and 15.0 cm proximally and repeating the procedure 7.5 and 15.0
cm distally. Circumferential measurements were then made at these five
levels to measure the amount of edema
3. Vital capacity assessment:.
Electronic spirometer used to measure forced vital capacity
Gripping force evaluation
It was used to measure hand grip an activity.
5.
Assessment of upper extremity function:
It includes the following items:
•Brush the hair
*Sweater over head.
*Pull on pants.
*Wash the upper part of your back (ipsilateral scapula).
*Wash the upper part of your back (contralateral scapula).
*Carry a grocery bag.
Pain Assessment: (VAS)
Physical Therapy Program :
1. P.T. methods to minimize pain:
Transcutaneous Electrical Nerve Stimulation (TENS):
TENS may be used successfully when the electrodes are placed over the site
of pain, in relation to a dermatome, employing trigger, acupuncture on
motor point, paravertebrally by identify a specific spinal cord segment for
stimulation or over a peripheral nerve.
Laser:
Laser is an acronym for light amplification by stimulated emission of
radiation. Lower- power laser or cold laser has been developed with
potential rehabilitative uses in pain management
*Interferential current
P.T. methods to control edema:
(a)
Elevation of an extremity above heart level + it must be maintained
while patient is in lying or sitting position.
(b) Active Exercises
It applies to shoulder - elbow- hand, muscles to increase skeletal muscle
pump and improve venous lymphatic drainage
High- voltage pulsed current (HVPC)
There are several devices and protocols for providing treatment with (HVPC).
The resolution of edema by using HVPC is probably due to activation of the
skeletal muscle pump or the negative polarity of the stimulation, which may
lead to fluid shift from the region.
P.T. methods to control edema:
Intermittent vasopneumatic compression
Extremity edema can be treated by using an intermittent compression
device, this device used to unilateral or bilateral hand/upper extremity
edema. There are two types of compression sleeves, either a single-cell
sleeve that apply equal pressure to an entire extremity or/a multiunit sleeve
that applies pressure sequentially from the distal to proximal
parts of the limb. Pressure is delivered at a time ratio of 3: 1 (three time
measures on, one time measure off). The most effective pressure of the
sleeve is equal to or slightly greater than patient’s diastolic blood pressure.
P.T. methods to improve respiratory function:
Methods to improve muscle power of diaphragm
1-Manual
2- Mechanical (Resisted breathing ex.)
3- Positioning
4- Incentive spirometer
To improve chest mobility
1- Deep breathing
2- Positive pressure breathing
3- Airshift maneuver
4- Manual chest stretching
5-Gloss-phazyngeal
To improve bronchial Hygiene•
1-Manual cough
2- Self manual cough
3- Postural drainage
4- Vibration & suction
P.T. methods to improve function
ROM for the upper Extremity In forms of
1.Codman’s pendulum exercises.
2.Shoulder Wheel exercises.
3.Pulley exercises.
4.Finger ladder exercises.
5.Wall and wall bars exercises.
6.Hand grip dynamometer exercises.
- Shoulder
- Elbow
-Hand