Resection

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

Ms. Barker had a bowel resection 4 days ago. After a culture and sensitivity test of her draining surgical wound, the primary health care provider orders penicillin G aqueous IV as a continuous drip. Determine what questions you would ask Ms. Barker before the penicillin is added to the IV solution. 

Persons who have had a total gastrectomy or subtotal gastric resection (when the cells producing the intrinsic factor are totally or partially removed)... 

Parenteral Fluids. During the past ten years interest has been renewed in the total alimentation of the infant by vein (2). The motivation for this is the fact that neonates may suffer from some congenital malformation of the intestinal tract which would require surgical resection. If this is done, then one needs some outside way for alimentation, bypassing the intestine, until the intestine is able to heal and recover its normal function. This may take many weeks. A second source of motivation is the small premature infant weighing less than a kilogram, whose immature central nervous system and gastrointestinal tract make it difficult to establish nutrition by oral intake soon after birth. These also require total intravenous nutrition for a substantial period of time. 

FIGURE 6.4 (a) Seventy-eight-year-old woman presenting with new onset vertigo and gait unsteadiness. Hypoattenuation of the left cerebellar hemisphere consistent with infarction, (b) Postoperative CT after suboccipital craniectomy and partial resection of the left cerebellar hemisphere. 

Topcu T, GULPiNAR M A, isMAN c A, YEGEN B c, YEGEN c (2002) Enterogasfric brake in rats with segmental bowel resection role of capsaicin-sensitive nerves. Clin Exp Pharmacol Physiol. 29 68-72. 

Small bowel resection, severe diarrhea, intractable vomiting, bowel obstruction, and fistulas ° Critically ill patients with nonfunctioning GI tract... 

A greater change in serum sodium may be required if severe signs/symptoms secondary to hyponatremia persist. Another exception may be hyponatremia occurring in the setting after transurethral resection of the prostate (TURP)... 

Coronary artery bypass graft surgery Pulmonary resection Thoracoabdominal esophagectomy Drugs 13... 

Treatment of distal intestinal obstruction syndrome (DIOS) consists of oral or nasogastric administration of polyethylene glycol electrolyte (PEG) solutions. Enemas may also be used to facilitate stool clearance. IV fluids are often required to correct dehydration due to vomiting or decreased oral intake. Re-evaluation of enzyme compliance and dosing is essential to prevent further episodes. Patients with recurrent symptoms may require daily PEG administration (Miralax ).5 Severe presentations of DIOS or initial meconium ileus may require surgical resection. 

Formation of strictures, abscesses, fistulae, and obstructions in patients with CD is possible. Patients with CD may develop significant weight loss or nutritional deficiencies secondary to malabsorption of nutrients in the small intestine, or as a consequence of multiple small- or large-bowel resections. Common nutritional deficiencies encountered in IBD include vitamin B12, fat-soluble vitamins, zinc, folate, and iron. Malabsorption in children with CD may contribute to significant reductions in growth and development. 

Surgical intervention is a potential treatment option in patients with complications such as fistulae or abscesses, or in patients with medically refractory disease. Ulcerative colitis is curable with performance of a total colectomy. Patients with UC may opt to have a colectomy to reduce the chance of developing colorectal cancer. Patients with CD may have affected areas of intestine resected. Unfortunately, CD may recur following surgical resection. Repeated surgeries may lead to significant malabsorption of nutrients and drugs consistent with development of short-bowel syndrome. 

Patients who have had multiple intestinal resections due to CD may have diarrhea related to the inability to reabsorb bile salts. Cholestyramine has been demonstrated to improve diarrheal symptoms in this population.8,15 NSAIDs should be avoided for pain management due to their ability to worsen IBD symptoms. Narcotic analgesics should be used with caution, as they may significantly reduce GI motility. 

Antibiotics have been studied based on the rationale that they may interrupt the inflammatory response directed against endogenous bacterial flora. Metronidazole and ciprofloxacin have been the two most widely-studied agents.32 Metronidazole may benefit some patients with pouchitis (inflammation of surgically-created intestinal pouches) and patients with CD who have had ileal resection or have perianal fistulas. Ciprofloxacin has shown some efficacy in refractory active CD. Both drugs may cause diarrhea, and long-term use of metronidazole is associated with the development of peripheral neuropathy. 

Antibiotics as above plus total resection Antibiotics as above plus removal of the graft... 

Surgical resection is considered the treatment of choice for Cushing s syndrome from endogenous causes if the tumor can be localized and if there are no contraindications. 

If endogenous Cushing s syndrome, determine if patient is an appropriate candidate for surgical resection of the tumor. Does the patient have any conditions that contraindicate surgical resection, such as advanced disease (metastatic adrenal carcinoma) ... 

If surgical resection does not achieve satisfactory disease control or is not indicated, evaluate the patient for pituitary radiation or bilateral adrenalectomy with concomitant pituitary radiation. 

O Surgical resection of the pituitary tumor through transsphenoidal pituitary microsurgery is the treatment of choice for most patients with growth hormone-producing pituitary adenomas. 

Menorrhagia also may be treated with the levonorgestrel-releasing intrauterine device (IUD). This is a very effective treatment that consistently reduces menstrual flow by 90% or greater.29,30 Its use has resulted in the postponement or cancellation of scheduled endometrial resection surgery or hysterectomy. Specifically, 60% of treated patients have been able to avoid hysterectomy.30,34,35... 

Flanigan RC, Reda DJ, Wasson JHM, et al. 5 year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia a Department of Veterans Affairs cooperative study. J Urol 1998 160 12-17. 

Unless the sphincter mechanism is compromised by surgery or trauma, SUI is exceedingly rare in males. The most common surgeries predisposing to SUI in males are radical prostatectomy for prostate cancer and transurethral resection of the prostate for benign prostatic hyperplasia. 

Short-gut syndrome (e.g., intestinal artresia, necrotizing enterocolitis, intestinal volvulus, massive resection secondary to inflammatory bowel disease, tumors, mesenteric thrombosis)... 

Since there is no true excretion of iron from the body, iron-deficiency anemia occurs mostly because of inadequate absorption of iron or excess blood loss. Inadequate absorption may occur in patients who have congenital or acquired intestinal diseases, such as inflammatory bowel disease, celiac disease, or bowel resection. Achlorhydria and diets poor in iron also may contribute to poor absorption of iron. In contrast, iron deficiency also may occur in patients who exhibit a higher rate of iron loss from the body. This is manifested in... 

O Most intraabdominal infections are secondary infections that are caused by a defect in the gastrointestinal tract that must be treated by surgical drainage, resection, and/or repair. 

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