Egd and Exlap

7/25/2019 Egd and Exlap

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Exploratory Laporatomy

What is Exploratory Laparotomy?

It is an operation where a cut is made into the abdomen.

A method to explore the abdomen, a diagnostic tool that allows physicians to examine

the abdominal organs.

Indication

Abdominal pain of unknown origin. In addition, bleeding into the abdominal cavity is

considered a medical emergency such as in ectopic pregnancies.

To determine the source of pain and perform repairs if needed

To examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes,

bladder, and rectum) for evidence of endometriosis.

Contraindications

leeding

Infection

!ailure to find the cause of the problem" more surgery or other treatments may be

needed

#oor healing of the incision

$amage, in%ury, or problems with the bowels

&isks of anesthesia

What to expect before the procedure (Pre-Op)

The doctor will do pre'operative evaluation in the clinic week before the procedure (if

not an emergency case).

#atient may need to undergo some routine tests before your operation example. heart

trace (*+), x'ray and blood tests for cardio'pulmonary clearance.

#atient will be admitted a day before the scheduled procedure.


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*onsents must be secured

#- for hours prior to the time of the procedure

If ordered by the physician, cleaning or fleet enema will be given for further bowel

preparation.

Insertion of Intravenous /ine

$iagnostic exams as ordered by the physician like *omplete blood count, blood typing,

urinalysis and ultrasound.

#re'operative medicines and antibiotics will be administered.

Instructions regarding change of gown, removal of %ewelries, dentures, contact lenses,

hair accessories, nail polish and make up will be given.

An hour before the scheduled operation, patient will be wheeled down to the delivery

room.

Abdominoperineal prep (shaving) will be done.

What to expect durin the procedure (Intra-Op)

#rior to the time of operation, patient will be wheeled in to the operating room where a

surgical nurse will do the necessary preparations such as placement of cardiac leads,

hooking to the cardiac monitor, oxygen administration thru nasal cannula, and placement

of leggings.

#atient0s obstetrician will probably meet him1her in the operating room where an

anesthesiologist will be ready.

#rior to the procedure, for verification that the right patient and right procedure will be

done, 23igning in2 will be called, wherein the patient will be asked to state in his1her full

name, date of birth, name of his1her surgeon and anesthesiologist, as well as the

procedure to be done.


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After the introduction of anesthesia, a curtain will be raised over the patient0s mid section

and his1her arms will be outstretched in order for the anesthesiologist and nurse to have

access to his1her I.4.

A !oley catheter will be inserted. This is not a painful procedure, and if you have an

anesthesia in you, you won0t feel it at all. Then the surgical nurse will clean the incision

site with betadine.

-nce an ade5uate level of anesthesia has been reached, the initial cut into the skin will

be made. The surgeon will then explore the abdominal cavity for disease.

Alternatively, samples of various tissues and1or fluids will be removed for further analysis

and will be sent to the laboratory for microscopic examination.

The surgeon will then close the incision.

What to expect after the procedure (Post-Op)

After the operation, you will be wheeled into recovery where you will be observed for two

hours as the anesthetic wears off.

6ou will be hooked to the cardiac monitor to check your vital signs, and you will also be

hooked to the oxygen.

#ost'operative medicines will be given to you. $epending upon the nature of your

surgery and your doctor0s assessment of your pain, you probably will be given a pain

drip to address the pain.

The foley catheter will remain until further orders.

After the recovery period, you will be transferred to your room if there are no

complications.

Turning from side to side is advised. An abdominal binder is applied to support your cut.

at nothing per mouth or take only sips of water or clear li5uids or as ordered by your

physician on the first day of operation or until flatus passed out.


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$ischarge instructions and wound care will be given to you by your bedside nurse.

!t home"

$uring the first two weeks, avoid tiring activities such as lifting heavy ob%ects.

3lowly increase your activities. egin with light chores, short walks, and some driving.

$epending on your %ob, you may be able to return to work.

To promote healing, eat a diet rich infruits and vegetables.

Try to avoid constipationby7

o ating high'fiber foods

o $rinking plenty of water

o 8sing stool softeners if needed

Take proper care of the incision site. This will help to prevent an infection.

!ollow your doctor0s instructions

Contact the doctor if any of the follo#in occurs"

!ever or chills

&edness, swelling, increasing pain, excessive bleeding, or any discharge from the

incision site

Increasing pain or pain that does not go away

6our abdomen becomes swollen or hard to the touch

$iarrhea or constipation that lasts more than 9 days

right red or dark black stools

$i::iness or fainting

ausea and vomiting
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*ough, shortness of breath, or chest pain

#ain or difficulty with urination

3welling, redness, or pain in your leg

$ource"

http711www.makatimed.net.ph1main.php;id

Esophaoastroduodenoscopy

What is Esophaoastroduodenoscopy?

It is also known as 8pper +I ndoscopy or +astroscopy. It is a

diagnostic procedure wherein a small camera is inserted down

the throat to directly see the esophagus, stomach and the

upper part of the small intestine (duodenum). It can be done

with or without sedation (depending on you)

Indications

#erformed to check possible symptoms of gastrointestinal disease such as

dyspepsia, ?eartburn, persistent vomiting, difficulty swallowing, loss of appetite, weight

loss, vomiting of blood, black stools, or anemia.

It can also be used to examine the status of a previously known gastrointestinal disease.

%o# to prepare for an E&'

#- for hours before the procedure.

Aspirin and other blood thinners (@arfarin, *lopidogrel, *ilosta:ol, ?eparin) are stopped

for several days before the procedure to lessen the risk of bleeding.

ring an adult companion to assist you after the procedure.

efore the procedure, an informed consent will be obtained from the patient.

The doctor explains the indications, nature, and relevant details as well as the risks,

benefits, alternatives, and complications of the procedure to the patient.Note: procedure usually takes about 30 minutes.
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What happens before an E&'?

. Anesthesia

After enough fasting, a local anesthetic (/idocaine) is sprayed to the back of the

throat to prevent coughing or gagging when the endoscope is inserted.

ida:olam (4ersed) ' provides moderate sedation and relieves anxiety during

the procedure Atropine ' to reduce secretion

+lucagon ' to relax smooth muscle

>. #atient will be re5uested to bite on to a mouth guard to protect his1her teeth.9. #ositioning.

lateral position B &ationale7 to facilitate clearance of pulmonary secretions and

provide smooth entry of the scope=. The endoscope is lubricated with a water'soluble lubricant.

C. Insertion of endoscope down the throat until it reaches the duodenum. *areful examinations of the esophagus, stomach, and the duodenum are

made. -ftentimes, a painless biopsy sample is taken through the endoscope

using a small forceps to test for bacteria or to be sent for microscopic

examination.

What happens after an E&'?

. The patient will be brought to the recovery area.

>. Assessment

level of consciousness, vital signs, oxygen saturation, pain level, and monitoring for

signs of perforation (ie, pain, bleeding, unusual difficulty swallowing, and rapidly

elevated temperature)9. After the patientDs gag reflex has returned, if the patient is having some throat

discomforts, patient may be given one of the following7

/o:enges

saline gargle oral analgesic agents

ote7 The patient will not be allowed to eat or drink anything until his1her gag reflex

returns to prevent choking.

What are the possible complications of E&'?


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It is generally safe and well'tolerated. *omplications may occur but are very, very rare.

/ow oxygen levels

low blood pressure

low heart rate

allergic reactions may be due to sedation

respiratory problems such as stridor or aspiration

pneumonia may occur but are very uncommon

bleeding may occur from a biopsy site

perforation or tears is more associated with therapeutic ndoscopy and is very

uncommon.

anything unusual noted after +$ should be immediately reported to the physician

$ource"

runner and 3uddarth0s Textbook of ed.'3urg. ursing >th ed. (> vols.) ' 3. 3melt:er,

et al., (/ippincott, >EE) 3

http711www.webmd.com1digestive'disorders1upper'endoscopyd

http711emedicine.medscape.com1article1CF='overview

http711www.hopkinsmedicine.org1healthlibrary1testGprocedures1gastroenterology1esophag

ogastroduodenoscopyGH>,#E1


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!ssinment in Competency !ppraisal

&esearch Topics7

+$ (sophagogastroduodenoscopy)

xploratory'/aparotomy

3ubmitted by7

+roup C

ary Jane alino

Alyssa *hryss raKa

ary Joy Jarin

ary Anthony /ao

@ilfred acional

3ubmitted to7

elted 3ales, &, A

*A II /ecturer

!ebruary E, >EF

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