Ebook Assessing and managing the acutely ill adult surgical patient: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Assessing and managing the acutely ill adult surgical patient: Part 2
Ebook Assessing and managing the acutely ill adult surgical patient: Part 2
Upper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2orporates the oesophagus, stomach, gallbladder and pancreas. The aims of this chapter are to provide information for nurses working on surgical wards that care for patients who have undergone upper gastrointestinal surgery (Box 8.1). information will firstly be presented on the common pathophysiolog Ebook Assessing and managing the acutely ill adult surgical patient: Part 2ical conditions detailing the diagnostic investigations. The major surgical procedures will then be addressed, including the specific pre-operative asEbook Assessing and managing the acutely ill adult surgical patient: Part 2
sessment, monitoring and preparation required, the operative procedure and the specific postoperative management and care. This section will include aUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2nt and preparation of the patient for surgery. Patients who are to undergo upper gastrointestinal surgical procedures also require some specific assessment and preparation, as detailed within this section. Patients undergoing upper gastrointestinal surgery will require the same general post-operativ Ebook Assessing and managing the acutely ill adult surgical patient: Part 2e care as those patients undergoing other major surgical procedures. The overall principles of post-operative management have been discussed in ChapteEbook Assessing and managing the acutely ill adult surgical patient: Part 2
r 3 and these should be considered alongside the information presented within this section.Box 8.1 Aims of the chapter.•To introduce the reader to theUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2patients with the common conditions•To discuss the major surgical procedures undertaken on the upper gastrointestinal tract with regards to specific pre-operative assessment, monitoring and preparation; the surgical procedure and post-operative care and managementOesophageal disordersApplied pathoph Ebook Assessing and managing the acutely ill adult surgical patient: Part 2ysiologyAchalasiaThis is a relatively rare condition whereby the passage of food slows down in the oesophagus due to dilatation and muscular hypertropEbook Assessing and managing the acutely ill adult surgical patient: Part 2
hy above the lower sphincter (Henry & Thompson, 2005). Longstanding disease can lead to the development of a malignancy, probably due to the inflammatUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2h permission from Blackwell)the oesophageal mucosa from food stasis. Dysphagia develops over time and initially the patient will only have an increased food transit time. Eventually patients will develop dysphagia and present with symptoms of regurgitation, weight loss and pain behind the sternum. F Ebook Assessing and managing the acutely ill adult surgical patient: Part 2igure 8.1 is a barium swallow X-ray showing early achalasia.Oesophageal stricturesBenign oesophageal strictures most commonly occur in the distal oesoEbook Assessing and managing the acutely ill adult surgical patient: Part 2
phagus as a result of gastro-oesophageal reflux disease (GORD) or oesophagitis. Chronic GORD results in inflammation and formation of scar tissue, whiUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2gure 8.3 Reflux oesophagitis.(from Castrolab.net - reproduced with permission)wall (compare normal appearance in Figure 8.2 with reflux oesophagitis in Figure 8.3). This can result in oesophageal shortening, although most oesophageal strictures are less than I cm in length.Upper Gastrointestinal Sur Ebook Assessing and managing the acutely ill adult surgical patient: Part 2gery 127In those patients who develop a stricture, the lower oesophageal sphincter pressure, oesophageal motility and gastric emptying are more severeEbook Assessing and managing the acutely ill adult surgical patient: Part 2
ly impaired than in those patients with GORD who have not developed this complication. Patients with an oesophageal stricture usually present with dysUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2ss seen in patients with malignant strictures is not often seen.Chronic oesophagitis may be treated with intraluminal oesophageal dilatation followed by treatment of the underlying cause of the reflux (Walsh, 2002). Failure to treat could lead to the development of Barrett's oesophagus, a condition Ebook Assessing and managing the acutely ill adult surgical patient: Part 2in which the normal squamous epithelium lining the oesophagus is replaced by columnar epithelium (see Figure 8.4). This is usually asymptomatic (WalshEbook Assessing and managing the acutely ill adult surgical patient: Part 2
, 2002) but predisposes the patient to a 50-fold increase in the incidence of adenocarcinoma (Lattimer el al., 2002).Oesophageal varicesThis is a seriUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2through the portal venous system results in portal hypertension. Portal hypertension is abnormally high blood pressure in the portalFigure 8.5 Oesophageal varices.(from Gastrolab.net - reproduced with permission)venous system (McCance & Huether, 2002). This is the part of the vascular system that ca Ebook Assessing and managing the acutely ill adult surgical patient: Part 2rries blood to the liver from the gastrointestinal tract, pancreas and spleen. High pressure in the portal veins causes collateral vessels to open betEbook Assessing and managing the acutely ill adult surgical patient: Part 2
ween the portal veins and the systemic veins, in which the blood pressure is considerably lower (McCance & Huether, 2002). If this pressure is maintaiUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and inco Ebook Assessing and managing the acutely ill adult surgical patient: Part 2here. Eventually one may rupture, causing massive blood loss through haematemesis, melaena or both (Walsh, 2002). Treatment options include intravariceal sclerotherapy (injection of an irritant solution into the varices causing thrombophlebitis and eventual development of scar tissue), banding via e Ebook Assessing and managing the acutely ill adult surgical patient: Part 2ndoscopy or the use of a compression balloon (balloon tamponade - see Figure 8.6). Drug therapy includes the administration of vasopressin or, more coEbook Assessing and managing the acutely ill adult surgical patient: Part 2
mmonly, glypressin. Glypressin is similar to antidiuretic hormone (ADH) and is a potent vasoconstrictor thus reducing portal vein pressure by limitingUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and incoUpper Gastrointestinal SurgeryIan Fe I steadIntroductionThe upper gastrointestinal tract extends from the mouth to the pylorus of the stomach and incoGọi ngay
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