Complications of surgery

Question 1

what are the cardio complications

Answer 1

haemorrhage, MI, DVT

Question 2

what are the types of haemorrhage complications

Answer 2

reactionary (immediate postoperative)

secondary (infection 5-6 days)

Question 3

how does a haemorrhage present

Answer 3

obvious

• tachycardia
• hypotension
• oliguria

Question 4

how can haemorrhage be avoided

Answer 4

meticulous technique, avoidance of sepsis, correction of coagulation disorders

Question 5

what is the mortality of post op MI

Answer 5

50%

Question 6

how do post op MIs usually present

Answer 6

often silent,
cardiac failure/ cardiogenic shock,
arrythmias

Question 7

how is MI avoided

Answer 7

delay of surgery after MI,
avoidance of perioperative hypotension,
correction of ischaemic heart disease

Question 8

what cause a DVT in surgery

Answer 8

immobility, hypercoagulable states

Question 9

does malignancy increase your risk of DVT

Answer 9

yes

Question 10

how does DVT present

Answer 10

low grade fever, unilateral ankle swelling, calf or thigh tenderness, increased leg diameter, shiny leg

Question 11

how are DVT investigated

Answer 11

D dimer test, doppler ultrasound, venography

Question 12

how are DVTs prevented

Answer 12

compression stockings, lose dose subcutaneous heparin, early mobilisation

Question 13

what are the resp complications

Answer 13

atelectasis (partial or complete collaspe of the lung due to deflation of the alveoli)

pneumonia

pulmonary embolus

Question 14

how are atelectasis and pneumonia linked

Answer 14

collapse of lung tissue can lead to infection

Question 15

what causes infection post op

Answer 15

anaesthesia- increases secretion, inhibits cilia

post op pain- inhibits coughing

aspiration- stomach contents

Question 16

how does a chest infection present

Answer 16

low grade fever (0-2 days), high grade fever (4-10),

dyspnoea

productive cough

confusion

Question 17

how do you prevent chest infestions

Answer 17

stopping smoking,
adequate analgesia,
physiotherapy

Question 18

what causes a post op PE

Answer 18

DVT

Question 19

what is the presentation of a PE

Answer 19

tachypnoea, dyspnoea,
confusion,
pleuritic pain, haemoptysis, cardiopulmonary arrest

Question 20

what are the two methods of V/Q scan

Answer 20

injection of albumin tagged with radionuclide

inhalation of gaseous radionuclide

Question 21

how is a PE prevented

Answer 21

compression stockings, low dose subcutaneous heparin,
early mobilisation,
anticoagulation in presence of DVT

Question 22

what are the GI complications

Answer 22

ileus,
anastomotic dehiscence (in colorectal resections),
adhesions

Question 23

what is an ileus

Answer 23

paralysis of intestinal motility,

Question 24

what causes an ileus

Answer 24

handling of bowel, peritonitis, retropertioneal injury, immobilisation, hypokalaemia, drugs

Question 25

how does an ileus present

Answer 25

vomiting, abdo distention, dehydration, silent abdomen

Question 26

how is an ileus prevented

Answer 26

minimal operative trauma, laparoscopy, avoidance of intrabdominal spesis

Question 27

what is anastomotic dehiscence

Answer 27

breakdown of anastomosis (intestinal, vascular, urological)

Question 28

what causes a anastomotic dehiscence

Answer 28

poor technique, poor blood supply, tension on anastomoses

Question 29

how does an intetsinal anastomotic dehiscence present

Answer 29

perionitis, abscess, ileus, fistula

Question 30

how does a vascular anastomotic dehiscence present

Answer 30

bleeding, haemorrhage

Question 31

how does a urological anastomotic dehiscence present

Answer 31

leakage or urine/ urinoma

Question 32

how are anastomotic dehiscence prevented

Answer 32

good technique and blood supply, no tension

Question 33

what are adhesions and give examples

Answer 33

fibrin turns into fibrous tissue - bowel to bowel - bowel to abdo wall/ other structures - lung to chest

Question 34

what causes adhesion

Answer 34

inflammatory response, ischaemia

Question 35

how do adhesions present

Answer 35

asymptomatic (to chest wall) intestinal obstruction (vomiting, pain, distention, constipation)

Question 36

how are adhesions prevented

Answer 36

no powder on gloves avoidance of infection laparoscopic surgery sodium hyaluronidate

Question 37

what are the wound complications

Answer 37

infections, dehiscence, hernia

Question 38

what are the exogenous and endogenous causes of wound infections

Answer 38

trauma- exogenous intestinal surgery- endogenous

Question 39

how do wound infections present

Answer 39

``` pyrexia (5-8 days) redness, pain, swelling, discharge ```

Question 40

how are wound infections prevented

Answer 40

``` pre-op prep, skin cleaning, aseptic technique, avoidance of contaminants, prophylactic antibiotics ```

Question 41

what are the urinary complications

Answer 41

acute retention of urine, urinary tract infection, urethral structure, acute renal failure

Question 42

what are the neurological complications

Answer 42

confusion, stroke, peripheral nerve lesions

Question 43

what can cause confusion

Answer 43

``` hypoxia (chest infection, PE, MI), oversedation, sepsis, electrolyte imbalance, stroke, hyper or hypoglycaemia, alcohol or tranquilliser withdrawal ```

Question 44

how does confusion present

Answer 44

disorientation (time, place), paranoia, hallucinations

Question 45

how is confusion avoided

Answer 45

maintain oxygenation, avoid dehydration, avoid sepsis, send home ASAP

Question 46

what are the objectives of enhanced recovery after surgery

Answer 46

``` to minimise post op complications and return patient to normality ASAP promote -pain control -GI function -mobility ```