Hospital Visit MED

1) Primary intention is used if wound margins can be approximated together. Common ways of achieving closure of wound edges include adhesive strips, sutures, grafts, flaps or superglue. From day 1-4, where the fibrin clot is formed at wound site, neutrophils and macrophages release cytokines which promotes phagocytosis of bacteria, followed by the process of granulation tissue formation. At day 5, collagen fibrils aid to bridge the wound incision. Wound closure is expected with sufficient tensile strength to remove the sutures after 7-10 days, and to regain 80% tensile strength after 3 months. A reduced wound opening minimizes microbiological contamination, leading to minimal scar formation and cosmetically pleasing recovery. Potential problems with primary intention is foreign material contamination, leading to tissue damage and abscess formation. When decontamination of wound is difficult, and immediate closure unadvisable, secondary intention will be used. 2) Local factors include tumour, infection and desiccation. Tumour reduces blood flow and impedes healing. Infection from bacterial colonization prolongs the inflammatory process, disturb clotting cascades and promote disordered leukocyte formation. Desiccation must be prevented as a moist environment is favorable for epithelialization, and prevents crust formation over the wound site. Other local factors are tissue type, oedema, trauma and wound size. Systematic factors include malnutrition, vascular insufficiency, age and chronic disease. Foods high in protein, iron, minerals (zinc and copper) and vitamins promoteswound recovery. A decrease in vascularity can cause ulcers due to decreased blood supply. Also, the elderly may experience slower wound recovery from impaired humoral responses and blood circulation. Chronic diseases such as CVD, diabetes mellitus and cancer may also compromise the body’s immunity. 3) One complication developed by the patient is ILEUS, a temporary absence of normal contractile movements, or non-mechanical blockage of the intestinal wall. This may have been caused by patient’s proctectomy, which may have lead to bloating, constipation and loss of appetite, as experienced by the patient. Ileus commonly occurs for 2472 hours after abdominal surgery, particularly when the intestines have been manipulated. Drugs administered to patient following surgery may also have cause ileus. Another complication faced is STOMA infection. A stoma is a surgically created opening on the abdomen which allows waste to exit the body. The patient experienced skin irritation complaints around the opening of the stoma and stoma bag, caused by contact with feces. This can cause formation of necrotic tissue which promotes bacterial aggregation on the superficial wound surface

4) Ileus is treated by refraining from eating (patient stopped eating for 10 days following surgery). Patient is given Intravenous drips and electrolytes to keep hydrated. He might be given pills (laxatives), suppositories, or enemas to activate bowel movements. The buildup of gas and liquid in the intestines can be relieved by passing a tube is through the nose or anus into the stomach or small intestine respectively, with suction applied to relieve pressure. Keeping the skin surrounding stoma clean is important to prevent bacterial colonization, particularly from feces. Patient’s wound dressing is changed daily for necrotic tissue to slough away. Antiseptics are also applied to prevent infection.