Post Operative Care of

Surgical Patients and Common

Surgical Diseases in Family
Practice
Fransiscus Arifin

Post Operative Surgical Care

What are the main concern (of
the patient and doctors) after
surgery ?

How is the operation ? Success/Not

Success/Any complications ?
How is the wound ?
What should I eat/not eat ?
What should I do/not do ?
How can I manage my pain ?

Wound
Definition:
Tissue discontinuity (due to any causes)
An injury to living tissue caused by a
cut, blow, or other impact, typically one
in which the skin is cut or broken
trauma; an injury, usually restricted to a
physical one with disruption of normal
continuity of structures.

Acute vs Chronic Wound

Acute

Chronic

Duration from Injury

Hours to Days

Weeks to Months

Phases of recovery

On Schedule

Delayed or no progress

Causes

Trauma

Trauma (at first),

infection, vascular
problems

Physiology

Normal

Abnormal

Management

Simple

Complex

Example

Cut by a knife

Diabetic foot

Chronic Wound
Definition : wound that does not heal in
normal healing time frame, due to one or
more causes such as infection, poor
blood supply, immune problem, or tissue
defect

Wound Healing Time Frame

Physiology of Wound Healing

Special Wounds
Stoma
Diabetic Wounds

Stoma Type
Tracheostomy
Gastrostomy
Yeyunostomy
Ileostomy
Colostomy
Uretrostomy

Diabetic Wound
3 major disruption
Infection (due to lower immune
resistance)
Vascular defect
Nerve damage

Surgical Nutrition
(Related to Wound Healing)
Macronutrients : Carbohydrates, Fat,
Protein
Micronutrients
Trace elements

Energy Sources
Carbohydrates
- Limited storage capacity, needed for CNS function
- Yields 3.4 kcal/gram
- Pitfall: too much=lipogenesis and increased CO2
production

Fats
- Major endogenous fuel source in healthy adults
- Yields 9 kcal/gm
- Pitfall: too little=essential fatty acid (linoleic acid
deficiency-dermatitis, increased risk of infections)

Protein
- Needed to maintain anabolic state (match
catabolism)
- Yields: 4 kcal/gm
- Pitfall: must adjust in patient with renal and hepatic
failure

Nutrition Requirements
Healthy Adults

Calories: 25-35 kcals/kg

Protein: 0.8-1 gm/kg
Fluids: 30 cc/kg

Requirement Change for the Surgical Patient

Special Considerations
- Stress : Injury or disease,Surgery

Pre-hospital/pre-surgical nutrition status

Nutrition
The surgical patient : Extraordinary
stressors (hypovolemia, hypervolemia,
bacteremia, medications)
- Wound Healing
Anabolic state, appropriate vitamins (A, C,
Zinc), and adequate kcals/protein.

Poor Nutrition=Poor Outcomes

- For every gram deficit of untreated
hypoalbuminemia there is ~30% increase
in mortality

Post-Operative Nutrition Requirements

Calories:
- 30-40 kcals/kg/day
- Patient on ventilator usually require less
calories ~20-25 kcal/kg

Protein:
- 1-1.8 grams/kg

Fluids:
- Individualized

Diet Advancement
Traditional Method:
- Start clear liquids when signs of bowel
function returns.
- Rationale : Nausea and vomiting due to
post operative ileus

Micronutrients in Wound Healing

Still disputed
Not necessary unless depleted
Vit A ,C and Zinc

Post Surgical Care of Common

Surgical Procedures

Common Assesments
Diagnosis (complete)
Indication for operation
Type of procedure
Days post op
Chief complaints
Physical examination

Hernia Surgery
What type of hernia ?
What type of procedure ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :
GI Tract : nausea,defecation
Hematologic : bleeding, infection

Evaluate : Wound, GI Tract, emergencies

Appendectomy
What type of appendicitis?
What type of procedure ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :
GI Tract : nausea,defecation
Hematologic : bleeding, infection

Evaluate : Wound, GI Tract, emergencies

ORIF
What type of fracture ?
What type of procedure ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :

Musculosceletal : Artery, venous, nervous,movement

Hematologic : bleeding, infection

Evaluate : Wound, movement, vascular,

nerve, emergencies

Burns
What type of burns (grade, area) ?
What type of procedure ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :

Skin : pain, scars,movement

Hematologic : bleeding, infection

Evaluate : Wound, movement,

emergencies

Mastectomy
What type of disease ?
What type of procedure (simple, radical,
modified radical) ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :

Metastases / recurrence
Hematologic : bleeding, infection

Evaluate : Wound, seroma formation, local

recurrence

Thyroidectomy
What type of disease ?
What type of procedure ? (total,subtotal etc) ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :

Metastases / recurrence
Nerve lesion : hoarseness, difficulty in swallowing liquids
Endocrine : hypothyroidism, hypoparathyroidism
Respiratory : signs of airway obstruction
Hematologic : bleeding, infection

Evaluate : Wound, seroma formation

Bowel Resection
What type of disease ?
What type of procedure ?
When it was done ?
Any complaints regarding :
- Location of the operation
- Involved system :

Metastases / recurrence
GI : defecation, flatus
Nutrition status
Hematologic : bleeding, infection

Evaluate : Wound, GI tract function, DRE

Common Surgical Diseases

in Family Practice

Phymosis and Paraphymosis

Paronychia

Lower Urinary Tract Symptoms (IPSS)