Week 4: Management of patients with abdominal surgery 2025
Learning Objectives:
1. Describe the common types of abdominal surgery and their common problems after the surgery
2. Aware the precautions in handling patients with surgical wounds, drains and drips.
3. Perform comprehensive physiotherapy assessment, chest physiotherapy and mobilization for
patients undergone abdominal surgery.
I. What is general surgery?
• General Surgery is a surgical specialty that includes the diagnosis and treatment of diseases
affecting the abdomen, digestive tract, endocrine system, breast, skin, and blood vessels (American
Medical Association, 2020)
a. Examples of general surgery:
• Abdominal surgery (Liver, biliary system, pancreas, kidney, etc.)
• Gastro-intestinal tract surgery (Oesophagus to anus)
• Neck surgery (Thyroid / ENT)
• Breast surgery
• Skin and microvascular surgery (skin and blood vessels)
• Urology surgery
• Trauma surgery
• Transplantation surgery
b. Types of operative procedures
Laparotomy (open surgery) Laparoscopic surgery
Robotic surgery Endoscopy
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Week 4: Management of patients with abdominal surgery 2025
II. Abdominal surgery
a. Common indications
• Appendicitis
• Perforated peptic ulcer (PPU)
• Tumour (Ca stomach, Ca colon, Ca liver, Ca pancreas, Ca ovary, etc)
• Trauma
• Secondary hemoperitoneum, pneumoperitoneum and peritonitis
• Intestinal obstruction
• Cholecystitis
• Inguinal hernia
b. Common operative procedures
• Appendectomy
• Cholecystectomy
• Esophagectomy
• Gastrectomy
• Colectomy
• Abdominal decompression
• Tumour excision
• Inguinal repair
• Exploratory laparotomy
c. Laparotomy vs laparoscopic surgery
Incisions in laparotomy
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Week 4: Management of patients with abdominal surgery 2025
Incisions of laparoscopic surgery
III. Post-operative complications
a. Effects of general anaesthesia (Jones & Moffatt, 2002) (Main & Denehy, 2016)
• Weaken respiratory muscles
• Reduce functional residual capacity (FRC) and vital capacity (VC)
• Reduce lung compliance
• Increase chance of airway obstruction & alveolar collapse
• Increase chance of ventilation/perfusion (V/Q) mismatch
• Affects lung mucociliary clearance
• These effects may persist for 5-10 day after the surgery
b. Common problems after a general surgery
• Wound pain
• Wound discharge or bleeding
• Wound infection
• Prolonged immobilization and physical deconditioning
• Pain in deep breathing, coughing, and huffing
• Lung collapse or atelectasis
• Sputum retention
• Chest infection or pneumonia
• DVT
c. Risk factors associated with increase complications and mortality:
• Ageing
• Obesity
• Smoker
• Pre-existing pulmonary or cardiac pathology
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Copyright©2025 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University. All Rights Reserved.
Week 4: Management of patients with abdominal surgery 2025
IV. Physiotherapy management
a. Read your patient’s bed notes & check vital chart (Temp, BP, HR, SpO2, RR)
• Identify the right patient
• Admission summary (C/O, active problem, patient’s background, impression/plan)
• Operation notes (type of surgery, time, blood loss, intra-op findings)
• Post-op management (BP control, bed rest, early mobilization?)
• Investigation & lab results (Imaging, ECG, lab tests)
• Update patient’s condition in the progress sheets
Important lab tests / lab results (refer to appendix)
Complete blood count Arterial Blood Gas Blood chemistry Others
(CBC) (ABG)
Red blood cell pH value Electrolytes Cardiac enzymes
Haemoglobin PO2 • Sodium • Troponin T (TnT)
White blood cell PCO2 • Potassium • Troponin I (TnI)
• Neutrophils HCO3 Live function test Others
• Lymphocytes Base excess • ALT/AST • Albumin
Platelets • Bilirubin • Blood glucose (h'stix)
• Alkaline phosphatase • C-reactive Protein (CRP)
Renal function test • Erythrocyte sedimentation
• Creatinine rate (ESR)
• Urea • INR
• D-dimer
b. Patient assessment (to identify problems & goals setting)
• Greetings to patients, introduce yourself
• Re-check vital signs if necessary
• Make sure pain control is adequate (Pain medication is the primary source of pain control)
➢ Oral / IV pain medicine / patient-controlled analgesia (PCA)
• Wound observation (Drain intact? Discharge? Blood? Surrounding soft tissue)
• Proper positioning for the assessment and intervention
• Subjective examination (Pain and other discomfort, motivation)
• Assess chest condition (Breathing pattern, expansion, auscultation, cough / huff)
• Joint ROM / Muscle strength / DVT assessment (Refer back to orthopaedic surgery)
• Bed mobility
• Ambulation
c. Physiotherapy intervention (Based on the problems and goals)
• Make sure pain control is adequate
• Breathing and coughing with wound support techniques
• Postural drainage, percussion & vibration if necessary
• Incentive spirometry (eg. Triflo)
• Joint mobilization & muscle strengthening
• DVT prevention (compression stocking, ankle toes exercise, mobilization)
• Mobility training (sit out, standing, walking, stairs)
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Week 4: Management of patients with abdominal surgery 2025
d. Evaluation
• Re-check vital signs after your intervention (extremely important!!)
• Sputum → small/moderate/large amount of whitish/yellowish spt cough out
• Auscultation → change of air entry, reduction of added sounds
• Mobility & walking → amount of assistance required, walking distance
• Patient education → patient can do self-treatment him/herself
e. Practical skills (videos uploaded to BlackBoard)
• Wound bracing
1. Breathing and coughing/huffing with therapist bracing
2. Education of patient self-bracing
• Mobilization with drips and drains
V. References:
• American Medical Association. (2020). Surgery — General Specialty Description.
Available at: https://freida.ama-assn.org/specialty/surgery-general
• Jones, M., & Moffatt, F. (2002). Cardiopulmonary physiotherapy. Oxford: BIOS
Scientific. p.39-40
• Main, E., & Denehy, L. (2016). Cardiorespiratory physiotherapy: Adults and
Paediatrics (Fifth edition.; E. Main & L. Denehy, Eds.). Edinburgh: Elsevier.
VI. Appendix:
Arterial Blood Gas & laboratory tests (Main & Denehy, 2016. P.63,72)
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Copyright©2025 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University. All Rights Reserved.
Week 4: Management of patients with abdominal surgery 2025
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Copyright©2025 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University. All Rights Reserved.
Week 4: Management of patients with abdominal surgery 2025
Case study – Liver cancer
A 60/M patient is a chronic drinker with the past medical history of DM, HT and liver cirrhosis.
He lives alone with the support by family members living apart. He complained of increasing
abdominal pain, ascites and jaundice. He attended a clinic for investigations. Laboratory test found
that he had significant increased of liver enzymes in the liver function test. CT abdomen showed
that there was a 5 cm tumour in his liver. Liver biopsy proved that he got a hepatocellular
carcinoma (HCC) that required surgical intervention.
After admitted a hospital, partial hepatectomy (open approach) was performed under general
anaesthesia. The surgery was smooth and successful. He was transferred to adult ICU for close
monitoring for 1 day. Then he was transferred back to surgical wound for further management.
You visit this patient on post-op day 2. His vitals: BP 110/85mmHg, HR 95 bpm, SpO2 96% on
2L O2 via nasal cannula, temperature 37.3oC. Pain medicine will be given prn for wound pain
relief. In his bed, a urinary foley, a wound drain and a IV infusion drip were attached to this patient.
Questions:
1. Identify the potential problems. How would you assess these problems?
2. Identify the goals of treatment in this case.
3. Design an appropriate intervention program to achieve your goals in (2)
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Copyright©2025 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University. All Rights Reserved.
