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COMAT: Surgery > Surgical Complications > Flashcards

Surgical Complications Flashcards

1
Q

what is atelectasis?

A

collapse of the alveoli

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2
Q

what are the signs of atelectasis?

A

fever, decreased breath sounds with rales, tachypnea, tachycardia, and increased density on CXR

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3
Q

what is atelectasis claim to fame?

A

most common cause of fever during PODs 1 and 2

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4
Q

what prophylactic measures can be taken to prevent atelectasis?

A

preoperative smoking cessation, incentive spirometry, good pain control

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5
Q

what is the treatment of atelectasis?

A

postoperative incentive spirometry, deep breathing, coughing, early ambulation, NT suctioning, and chest PT

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6
Q

what is postoperative respiratory failure?

A

respiratory impairment with increased respiratory rate, shortness of breath, dyspnea

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7
Q

what is the treatment of postoperative respiratory failure?

A

supplemental O2, chest PT; suctioning, intubation, and ventilation of necessary

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8
Q

what is the initial workup of postoperative respiratory failure

A

ABG, CXR, EKG, pulse oximetry, and auscultation

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9
Q

what are the indications for intubation and ventilation

A

cannot protect airway, excessive work of breathing, progressive hypoxemia, progressive acidosis

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10
Q

what is the treatment of postoperative wheezing?

A

albuterol nebulizer

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11
Q

why may it be dangerous to give a patient with chronic COPD supplemental oxygen?

A

this patient uses relative hypoxia for respiratory drive and supplemental O2 may remove this drive

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12
Q

what is a pulmonary embolism (PE)?

A

DVT that embolisms to the pulmonary arterial system

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13
Q

what is DVT?

A

deep vein thrombosis - a clot forming in the pelvic or Lower extremity veins

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14
Q

what are the sign/symptoms of DVT

A

lower extremity pain, swelling, tenderness, Homan’s sign, PE

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15
Q

what is Homan’s sign?

A

calf pain with dorsiflexion of the foot classically seen with DVT

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16
Q

what test is used to evaluate for DVT?

A

duplex ultrasonography

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17
Q

what is Virchow’s triad?

A

stasis
endothelial injury
hypercoaguable state

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18
Q

what are the signs/symptoms of PE?

A

shortness of breath, tachypnea, hypotension, CP, occasional fever, loud pulmonic component of S2, hemoptysis with pulmonary infarction

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19
Q

what are the associated lab findings with PE

A

ABG - decreased pO2 and pCO2 from hyperventilation

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20
Q

what diagnostic test is indicated for PE

A

CT angiogram

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21
Q

what are the X-ray signs associated with PE

A
  • Westermark’s sign = wedge-shaped area of decreased pulmonary vasculature resulting in hyperlucency
  • opacity with base at pleural edge from pulmonary infarction
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22
Q

what are the EKG findings associated with PE

A

most are abnormal
classic finding is:
- cor pulmonale = S1Q3T3 RBBB and right-axis deviation
EKG most commonly shows flipped T waves or ST depression

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23
Q

what is a ‘saddle’ embolus

A

PE that ‘straddles’ the pulmonary artery and is in the lumen of both the right and left pulmonary arteries

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24
Q

what is the treatment of PE if the patient is stable

A

anticoagulation - heparin followed by LT warfarin or Greenfield filter

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25
Q

what is an IVC filter

A

metallic filter placed into IVC via jugular vein to catch emboli prior to lodging in the pulmonary artery

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26
Q

when is an IVC filter indicated

A

if anticoagulation is contraindicated or patient has further PE on adequate anticoagulation or is high risk

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27
Q

what is the treatment of PE if the patient is unstable

A

consider thrombolytic therapy
consult thoracic surgeon for possible Trendelenberg operation’
consider catheter suction embolectomy

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28
Q

what is the Trendelenberg operation

A

pulmonary artery embolectomy

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29
Q

what is a ‘retrievable’ IVC filter

A

IVC filter that can be removed

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30
Q

what is aspiration pneumonia

A

pneumonia following aspiration of vomitus

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31
Q

what are the signs/symptoms of aspiration pneumonia

A

respiratory failure, CP, increased sputum production, fever, cough, mental status changes, tachycardia, cyanosis, infiltrate on CXR

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32
Q

what is the treatment of aspiration pneumonia?

A

bronchoscopy, abx if pneumonia develops, intubation if respiratory failure occurs, ventilation with PEEP if ARDS occurs

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33
Q

what is Mendelson’s syndrome

A

chemical pneumonitis secondary to aspiration of stomach contents

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34
Q

are prophylactic abx indicated for aspiration pneumonitis

A

NO

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35
Q

what are the risk factors for gastric dilatation?

A

abdominal surgery, gastric outlet obstruction, splenectomy, narcotics

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36
Q

what are the signs/symptoms of gastric dilatation?

A

abdominal distention, hiccups, electrolyte abnormalities, nausea

37
Q

what is the treatment of gastric dilatation?

A

NGT decompression

38
Q

what do you do if you have a patient with high NGT output?

A

check high abdominal X-ray and if the NGT is in duodenum, pull back the NGT into the stomach

39
Q

what is postoperative pancreatitis?

A

pancreatitis resulting from manipulation of the pancreas during surgery or low blood flow during the procedure, gallstones, hypercalcemia, medications, idiopathic

40
Q

what lab tests are performed for postoperative pancreatitis?

A

amylase and lipase

41
Q

what is the initial treatment for postoperative pancreatitis?

A

same as for other causes of pancreatitis

- NPO, aggressive fluid resuscitation, +/- NGT PRN

42
Q

what are the postop causes of constipation?

A

narcotics, immobility

43
Q

what is the treatment of constipation?

A

OBR

44
Q

what is OBR?

A

ortho bowel routine

- docusate sodium, dicacodyl suppository if no BM occurs, fleet enema if suppository ineff

45
Q

what is short bowel syndrome?

A

malabsorption and diarrhea resulting from extensive bowel resection

46
Q

what is the initial treatment of short bowel syndrome?

A

TPN early, followed by many small meals chronically

47
Q

what is blind loop syndrome?

A

bacterial overgrowth in the small intestine

48
Q

what are the causes of blind loop syndrome?

A

anything that disrupts the normal flow of intestinal contents (causes stasis)

49
Q

what are the surgical causes of vitamin B12 deficiency?

A

blind loop syndrome, gastrectomy (decreased secretion of intrinsic factor), and excision of the terminal ileum (site of B12 absorption)

50
Q

what is postvagotomy diarrhea?

A

diarrhea after a truncal vagotomy

51
Q

what is the cause of postvagotomy diarrhea?

A

a rapid transport of bile salts to the colon results in osmotic inhibition of water absorption in the colon, leading to diarrhea

52
Q

what is dumping syndrome?

A

delivery of hyper osmotic chyme to the small intestine causing massive fluid shifts into the bowel
- normally the stomach will decrease the osmolality of the chyme prior to its emptying

53
Q

with what conditions is dumping syndrome associated?

A

any procedure that bypasses the pylorus or compromises its function

54
Q

what are the signs/symptoms of dumping syndrome

A

postprandial diaphoresis, tachycardia, abdominal pain/distention, emesis, increased flatus, dizziness, weakness

55
Q

what is the medical treatment of dumping syndrome

A

small, multiple, low-fat/carbohydrate meals that are high in protein content

56
Q

what is the surgical treatment of dumping syndrome

A

conversion to Roux-en-Y

57
Q

what is diabetic ketoacidosis (DKA)?

A

deficiency of body insulin resulting in hyperglycemia, formation of ketoacids, osmotic diuresis, and metabolic acidosis

58
Q

what are the signs of DKA

A

polyuria, tachypnea, dehydration, confusion, abdominal pain

59
Q

what is the treatment for DKA

A

insulin drip, IVF rehydration, K+ supplementation, +/- bicarbonate IV

60
Q

what electrolyte must be monitored closely in DKA

A

potassium and HYPOkalemia

- correction of acidosis and GLC/insulin drive K+ into cells and are treatment for HYPERkalemia

61
Q

what must you rule out in a diabetic with DKA

A

infection

62
Q

what is Addisonian crisis?

A

acute adrenal insufficiency in the face of a stressor

63
Q

what is the cause of Addisonian crisis?

A

postoperatively, inadequate cortisol release usually results from steroid administration in the past year

64
Q

what are the signs/symptoms of Addisonian crisis?

A

tachycardia, nausea, vomiting, diarrhea, abdominal pain, +/- fever, progressive lethargy, hypotension, eventual hypovolemic shock

65
Q

what is Addisonian crisis’ clinical claim to fame?

A

tachycardia and hypotension refractory to IVF and pressors

66
Q

which lab values are classic for Addisonian crisis?

A 
hyponatremia
hyperkalemia (secondary to decreased aldosterone)
67
Q

what is the treatment for Addisonian crisis?

A

IVFs (D5NS), hydrocortisone IV, fludrocortison PO

68
Q

what is fludrocortisone?

A

mineralocorticoid replacement (aldosterone)

69
Q

what is SIADH?

A

syndrome of inappropriate antidiuretic hormone secretion

70
Q

what does ADH do?

A

ADH increases NaCl and H2O resorption in the kidney, increase intravascular volume
- released from posterior pituitary

71
Q

what are the causes of SIADH?

A

mainly lung/CNS

72
Q

what are the associated lab findings with SIADH?

A

hyponatremia
hypochloremia
low serum osmolality
increased urine osmolality

73
Q

how can the serum sodium level in SIADH be remembered

A

Sodium Is Always Down Here

74
Q

what is the treatment of SIADH

A

treat the primary cause and restrict fluid intake

75
Q

what is diabetes insipidis (DI)

A

failure of ADH renal fluid conservation resulting in dilute urine in large amounts

76
Q

what is the source of ADH

A

posterior pituitary

77
Q

what are the two major types of DI

A

central (neurogenic)
- decreased production of ADH
nephrogenic
- decreased ADH effect on kidney

78
Q

what are the classic causes of central DI

A

brain injury, tumor, surgery, and infection

79
Q

what are the classic causes of nephrogenic DI

A

Amphotericin B, hypercalcemia, and chronic kidney infection

80
Q

what lab values are associated with DI

A

hypernatremia
decreased urine sodium
decreased urine osmolality
increased serum osmolality

81
Q

what is the treatment of DI

A

fluid replacement
follow Na+ levels and urine output
central DI warrants vasopressin
nephrogenic DI may respond to thiazide diuretics

82
Q

what is DIC

A

activation of the coagulation cascade leading to thrombosis and consumption of clotting factors and platelets and activation of fibrinolytic system (fibrinolysis), resulting in bleeding

83
Q

what is the treatment of DIC

A

removal of the cause, otherwise supportive: IVF, O2, platelets, FFP, cryoprecipitate,
use of heparin is indicated in cases that are predominantly thrombotic with antithrombin III supplementation as needed

84
Q

what is abdominal compartment syndrome ?

A

increased intra-abdominal pressure usually seen after laparotomy or after massive IVF resuscitation (burn)

85
Q

what are the signs/symptoms of abdominal compartment syndrome?

A

tight distended abdomen, decreased urine output, increased airway pressure, increased intra-abdominal pressure

86
Q

how do you measure intra-abdominal pressure?

A

read intrabladder pressure

87
Q

what is the normal intra-abdominal pressure?

A

<15mmHg

88
Q

what intra-abdominal pressure indicates need for treatment?

A

> 25mmHg

89
Q

what is the treatment of abdominal compartment syndrome?

A

release of pressure by decompressive laparotomy (leaving fascia open)

COMAT: Surgery (17 decks)

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