PRE OPERATIVE BOWEL PREPARATION

PRE OPERATIVE BOWEL PREPARATION : 

PRE OPERATIVE BOWEL PREPARATION The presence of bowel contents during surgery has been related to anaestomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions

GASTROINTESTINAL PREPARATIONS : 

GASTROINTESTINAL PREPARATIONS In emergency situations, the insertion of nasogastric tube to evacuate the gastric contents is mandatory. Its use has reduced the incidence of aspiration during induction of anesthesia.

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In elective surgery patient with pyloric stenosis may require frequent gastric wash via nasogastric tube with isotonic saline

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Adequate bowel preparation is necessary in colorectal surgery.Both mechanical preparation and bowel sterlisation-as they reduce infection and leakage rates

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Traditional mechanical cleansing of colon is done with liquid low residue diet,purgation,and colonic washout with tap water or phosphate enema-mostly done by polyethylene glycol(peg)

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Mechanical preparation of colon is often incomplete in the presence of distal stenosis-proximal colon has to be cleared out of faecal matter at the time of surgery –two techniques

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First method (retrograde)uses a special tube, muirs tube introduced via a colotomy proximal to the stenosing lesion

ENEMAS : 

ENEMAS Procedure of introducing liquids into rectum and colon via the anus Rapid expansion of lower intestinal tract -uncomfortable bloating -> cramp,powerful peristalis->urgency,complete evacuation of lower intestinal tract

REASON : 

REASON WHY ENEMA NECESSARY B4 ABDOMINAL PROCEDURE ? POSSIBILITY OF DAMAGE TO INTESTINE->PERITONITIS

PRECAUTIONS : 

PRECAUTIONS REPEATED ENEMAS-ELECTROLYTE IMBALANCE RUPTURE TO BOWEL OR RECTAL TISSUES->INTERNAL BLEEDING->EXPOSURE TO INFECTION FROM INTESTINAL BACTERIA ENEMA TUBE AND SOLUTION MAY STIMULATE VAGUS NERVE ->ARRHYTHMIA SUCH AS BRADYCARDIA

CONTRAINDICATION : 

CONTRAINDICATION ENEMA NOT TO BE USED IN UNDIAGNOSED ABD PAIN SINCE PERISTALSIS OF BOWEL CAN CAUSE INFLAMED APPENDIX TO RUPTURE COLONIC IRRIGATION SHOULD NOT BE USED IN DIVERTICULITIS,ULCERATIVE COLITIS,CHRONS DISEASE,RECTAL/COLON CANCER

COLOSTOMY : 

COLOSTOMY Artificial opening made in the large bowel to divert faeces and flatus to the exterior - collected in an external appliance.

TYPES : 

TYPES Temporary Permanent

TEMPORARY COLOSTOMY : 

TEMPORARY COLOSTOMY Bringing a loop of colon to the surface of abdominal wall Held in place by a plastic bridge passed through the mesentry Once abdomen is closed colostomy is opened and the edges are sutured to the adjacent skin margins Once skin adhesion has taken place bridges can be removed

TEMPORARY COLOSTOMY : 

TEMPORARY COLOSTOMY Commonly done to defunction an anaestomosis after an anterior resection. following traumatic injury to rectum & colon, Facilitate the operative treatment of a high fistula in ano Thus it prevents spillage of the bowel contents into the peritoneum, thus reducing the chances of faecal peritonitis

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Usually done on transverse colon or sigmoid colon. Reasons Presence of mesentery Not retroperitoneal Contrast examination of the distal loop can be done to check for distal obstruction or continuing problem Colostomy can be closed once the stoma is mature.

Permanent colostomy : 

Permanent colostomy Usually formed after the excision of the rectum for carcinoma Formed by bringing the distal end of the of the divided colon to the surface in the left illiac fossa, then it is sutured in place The site at which the bowel is brought out is selected so that colostomy bag doesn’t impinges on bony prominence.

Colostomy bag and appliances : 

Colostomy bag and appliances

Complications : 

Complications Prolapse Retraction Necrosis Stenosis Herniation Bleeding Colostomy diarrhoea