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Flashcards in Anastamotic Leak Deck (8)
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1
Q

What is anastomotic leak?

A

Leak of luminal contents from a surgical join between two hollow viscera.

2
Q

What are the risk factors for anastomotic leak?

A

Emergency surgery or longer intra-operative time
Peritoneal cotamination
Oesophargeal-gastric or rectal anastomosis
Medications
Smoking/alcohol excess
Diabetes or obesity/malnutrition

3
Q

What medications cause anastomotic leak?

A

Corticosteroids
Infliximab (anti-TNF monoclonal antibody) - slows wound healing but no impact on rate of anastomotic leak
Mycophenolate (immunosuppressant) - increases AL risk
Azathiprine (immunosuppressant)
Bevacizumab (VEGF inhibitor)

4
Q

What are the clinical features of anastomotic leak?

A

Abdo pain
Fever
5-7 days post-op
OE
pyrexial, tachycardia, peritonism or prolonged ileus (painfuls obstruction of intestine)
Important to check for feculent/purulent material or bile in the wound drain or chest drain for oesophageal anastomoses

5
Q

What are the investigations for anastomotic leak?

A

Urgent bloods = FBC, CRP, U&E, LFT clotting
VBG for tissue perfusion
G&S
definitive diagnosis - CT scan with contrast of abdomen and pelvis for present of extraluminal contents

6
Q

What is initial management of anastomotic leak?

A
NBM 
Broad spectrum antibiotic cover
Sepsis pathway 
IV fluid therapy 
Insert urinary catheter
Measure fluid balance
7
Q

What is the definitive management of anastomotic leak?

A

Minor leaks - obs and bowel rest with percutaneous drainage if necessary
Major leak - exploratory laparotomy whereby surgical intervention may involve stoma formation or diversion/stenting with an abdominal washout

8
Q

How long after surgery do anastomotic leaks present?

A

5-7 days