Complications of surgery

Question 1

Cardiovascular complications

Answer 1

Haemorrhage - reactionary, or secondary

M.I.

DVT

Question 2

Reactionary haemorrhage

Answer 2

Immediate postoperative

Question 3

Secondary haemorrhage

Answer 3

Infection (5-10 days)

Question 4

Presentation of haemorrhage

Answer 4

Over
Tachycardia
Hypotensive
Oliguria

Question 5

Prevention of haemorrhage

Answer 5

Meticulous technique
Avoidance of sepsis
Correction of coagulation disorders

Question 6

MI presentation

Answer 6

Often silent (due to anaesthetics)

Cardiac failure/cardiogenic shock

Arrhythmias

Question 7

MI Prevention

Answer 7

Delay surgery after an MI

Avoidance of preoperative hypotension

Correction of ischaemic HD first (stents)

Question 8

DVT - risk, caused by

Answer 8

Increased risk - Age>40

Previous DVT
Majour surgery
Obesity
Malignancy

Caused by//

Immobility during surgery
Hypercoagulable state

Question 9

DVT presentation

Answer 9

Low grade fever
Unilateral ankle swelling
Calf or thigh tenderness
Increased leg diameter
Shiny skin

Question 10

DVT investigation

Answer 10

D dimer test - rule out test

Doppler ultrasound

Venography

Question 11

DVT prevention

Answer 11

Compression stockings
Low does SC heparin

Early mobilisation

Question 12

Respiratory

Answer 12

Atelectasis
Pneumonia
PE

Question 13

Atelectasis

Answer 13

Collapse of lung tissue –> infection

Anaesthesia - increases secretion, inhibits cilia

Postoperative pain
- inhibits coughing

Aspiration
- stomach contents

Question 14

Chest infection - presentation

Answer 14

Low/high grade fever

Dyspnoea
Productive cough
Confusion

Question 15

What is confusion related to?

Answer 15

Hypoxia

Question 16

Chest infection - prevention

Answer 16

Stop smoking
Adequate analgesia
Physiotherapy

Question 17

Pulmonary embolism

Answer 17

DVT

Tachypnoea
Dyspnoea
Confusion
Pleuritic pain
Haemoptysis
Cardiopulmonary arrest

Question 18

Ileus (paralytic)

Causes

Answer 18

Paralysis of intestinal motility

Causes/

Handling of bowel

Peritonitis

Retroperitoneal injury

Immobilisation

Hypokalaemia

Drugs

Question 19

Ileus - presentation

Answer 19

Vomiting
Abdo distension
Dehydration
Silent abdomen

Question 20

Ileus - prevention

Answer 20

Minimal operative trauma

Laparoscopy

Avoidance of intra-abdo sepsis

Question 21

Anastomotic dehiscence

Answer 21

Breakdown of anastomosis (connection of tissue surgically)

Caused by/

Poor technique
Poor blood supply
Tension on anastomosis

Question 22

Anastomotic dehiscence - presentation

Answer 22

Intestinal

• peritonitis
• abscess
• ileus
• fistula

Vascular
- bleeding, haematoma

Urological
- leakage of urine/urinoma

Question 23

Anastomotic dehiscence - prevention

Answer 23

Good technique
Good blood supply
No tension

Question 24

Adhesions

• what is it
• caused by

Answer 24

Fibrin –> Fibrous tissue

• bowel to bowel
• bowel to abdominal wall
• lung to chest wall

Caused by

• inflammatory response
• ischaemia

Question 25

Adhesions - presentation

Answer 25

Asymptomatic - to chest wall Intestinal obstruction - vomiting - pain - distension - constipation

Question 26

Adhesions - prevention

Answer 26

Avoidance of infection laparoscopic surgery Sodium hyaluronidate

Question 27

Wound infection

Answer 27

Trauma - exogenous Intestinal surgery - endogenous (bacteria in the intestine spills into peritoneal cavity/ wound)

Question 28

Wound infection - presentation

Answer 28

``` Pyrexia Redness Pain Swelling Discharge ```

Question 29

Wound infection - prevention

Answer 29

Pre-op prep Skin cleansing Aseptic technique Avoidance of contamination Prophylactic antibiotics - high risk ops

Question 30

Urinary complications

Answer 30

Acute retention of urine UTI - catheter Urethral stricture - can occur after prolonged use of catheters

Question 31

Neurological complicaitons

Answer 31

Confusion - hypoxia, PE, MI Stroke Peripheral nerve lesions - ulnar nerve - radial nerve - sciatic nerve - common perineal nerve

Question 32

Confusion - causes

Answer 32

``` Hypoxia Chest infection PE MI Oversedation Sepsis Electrolyte imbalance Stroke Hyper or hyopglycaemia Alcohol or tranquilliser withdrawal ```

Question 33

Confusion - presentation

Answer 33

Disorientation - time - place Paranoia Hallucinations

Question 34

Confusion - prevention

Answer 34

Maintain oxygenation Avoid dehydration Avoid sepsis Send home ASAP

Question 35

Enhanced recovery after surgery (EHAS)

Answer 35

Enhanced care Minimise post-op complications Promotes - pain control, GI function, mobility Pre op: Admission counselling, no prolonged fasting Periop - short acting anaesthetic agents - no drains Post-op - early removal of catheter, early oral nutrition, no NG tubes