Abdominal surgery

TAC of patients subjected to surgery (abdominal or breast cancer operations) showed remarkable stability, showing small changes (increase or decrease) immediately after and 6 hr after surgery and normalizing 12 hr after surgery (M28). 

Patients with a high risk for clotting require thromboprophylaxis. Some risk factors for venous thromboembolism include age greater than 40 years, prolonged immobility, history of prior venous thromboembolism (DVT, pulmonary embolism [PE]), cancer, major surgery (abdominal, pelvic, or lower extremity), fracture (pelvis, hip, or leg), CHF, Ml, stroke, obesity, and high-dose estrogen use. 

For the prevention of VTE, the LMWHs have been studied in a variety of high-risk circumstances, including orthopedic surgery, abdominal surgery, acute spinal cord injury, neurosurgery, multiple trauma, and critical ihness. The effectiveness of the LMWHs has been evaluated extensively for the treatment of VTE in hospitalized patients and used in the outpatient management of DVT. They are also a reasonable altemative to warfarin therapy in cancer patients with recurrent VTE and circumstances where a prothrombin time/international normalized ratio (PT/INR) cannot be obtained routinely. 

Prevention of DVT and PE (antithrombotic prophylaxis) is another common indication for UFH, LMWH or coumarin, especially following surgery or immobilizing trauma. Fondaparinux is approved for prevention of DVT and PE after hip and knee surgery, and following abdominal surgery. 

Because the oral aminoglycosides are poorly absorbed, they are useful to suppressing gastrointestinal bacteria The oral aminoglycosides kanamycin (Kantrex) and neomycin (Mycifradin) are used preoperatively to reduce the number of bacteria normally present in the intestine (bowel prep). A reduction in intestinal bacteria is thought to lessen the possibility of abdominal infection that may occur after surgery on the bowel. 

A. abdominal surgery requires starting antibiotic therapy 4 days before surgery... 

Enflurane (Ethrane) is a volatile liquid anesthetic that is delivered by inhalation. Induction and recovery from anesthesia are rapid. Muscle relaxation for abdominal surgery is adequate, but greater relaxation may be necessary and may require the use of a skeletal muscle relaxant. Enflurane may produce mild stimulation of respiratory and bronchial secretions when used alone Hypotension may occur when anesthesia deepens. 

Prevention of postoperative venous thrombosis (DVT) and PE in certain patients undergoing surgical procedures, such as major abdominal surgery ... 

In general these derivatives are safe, their chemical functions being the glycine moiety the same holds for AT,0-carboxymethyl chitosan, as demonstrated for instance by studies intended to assess the efficacy of W,0-carboxymethyl chitosan to limit adhesion formation in a rabbit abdominal surgery model. The inability of fibroblasts to adhere to N,0-carboxymethyl chitosan-coated surfaces suggests that it may act as a biophysical barrier [135]. 

Surgical intervention is a viable alternative for selected patients with well-documented GERD.1 The goal of surgery is to re-establish the anti-reflux barrier, to position the lower esophageal sphincter within the abdomen where it is under positive (intra-abdominal) pressure, and to close any associated hiatal defect.11 It should be considered in patients who (1) fail to respond to pharmacologic treatment (2) opt for... 

A 57-year-old woman is scheduled for an abdominal hysterectomy due to uterine fibroids. She is very anxious about her surgery. 

Extensive abdominal surgery may preclude peritoneal dialysis. 

Epidural analgesia is frequently used for lower extremity procedures and pain (e.g., knee surgery, labor pain, and some abdominal procedures). Intermittent bolus or continuous infusion of preservative-free opioids (morphine, hydromorphone, or fentanyl) and local anesthetics (bupivacaine) may be used for epidural analgesia. Opiates given by this route may cause pruritus that is relieved by naloxone. Adverse effects including respiratory depression, hypotension, and urinary retention may occur. When epidural routes are used in narcotic-dependent patients, systemic analgesics must also be used to prevent withdrawal since the opioid is not absorbed and remains in the epidural space. Doses of opioids used in epidural analgesia are 10 times less than intravenous doses, and intrathecal doses are 10 times less than epidural doses (i.e., 10 mg of IV morphine is equivalent to 1 mg epidural morphine and 0.1 mg of intrathecally administered morphine).45... 

Previous local surgery/radiation Prostate surgery, lower abdominal cavity... 

A 48-year-old woman was admitted to the intensive care unit with sepsis and hemodynamic instability. Three days earlier, she had undergone an abdominal surgery. After treatment with intravenous antibiotics and fluid administration, the patient was described as stable. Several hours later, the patient s nurse identified extravasation from the intravascular lines and abdominal drains. 

A 52-year-old man was admitted to the hospital for abdominal surgery. He developed complications postoperatively and was intubated 6 days ago. The nurses note an increase in the amount and purulence of his sputum. Attempts yesterday and today to wean the patient off the ventilator have failed. He is sedated but does respond to commands. His temperature is 38.4°C, his blood pressure is 120/84 mm Hg, and his white blood cell (WBC) count is 14.2/mm3 with a cell differential of 76% neutrophils, 4% bands, 16% lymphocytes, and 4% monocytes. 

Risk factors include increased age, recent abdominal surgery, increased number of C. difficile diarrheal episodes, and leukocytosis. 

Colonization at multiple distinct body sites or with high density of Candida species, however, often precedes invasive infection. Preemptive antifungal therapy may be indicated in colonized high-risk populations such as neutropenic fever, transplant recipients, or following major abdominal surgery. 

Would it be prudent to start jejunal feedings immediately after the patient is admitted to the intensive-care unit following his abdominal surgery ... 

Sganga G New perspectives in antibiotic prophylaxis for intra-abdominal surgery. J Hosp Infect 2002 50(suppl A) S 17-S21. 

The most common indication for surgery in CP is abdominal pain refractory to medical therapy. Surgical procedures that alleviate pain include a subtotal pancreatectomy, decompression of the main pancreatic duct, or interruption of the splanchnic nerves. 

The Study on the Efficacy of Nosocomial Infection Control (SENIC) analyzed more than 100,000 surgery cases and identified abdominal operations, operations lasting more than 2 hours, contaminated or dirty procedures, and more than three underlying medical diagnoses as factors associated with an increased incidence of SSI. When the NRC classification described in Table 48-1 was stratified by the number of SENIC risk factors present, the infection rates varied by as much as a factor of 15 within the same operative category. 

Risk factors for ARF include advanced age, acute infection, preexisting chronic respiratory or cardiovascular disease, dehydration, and chronic kidney disease (CKD). Decreased renal perfusion secondary to abdominal or coronary bypass surgery, acute blood loss in trauma, and uric acid nephropathy also increase risk. 

Figure 1.2 shows differently prepared skin membranes. The individual membranes were prepared from freshly excised human abdominal skin, originating from females undergoing reductive surgery. Samples were fixed with xylol, stained with hematoxylin/eosin, and embedded into paraffin. Cross sections with a thickness of 4 fzm were prepared using a microtome. 

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