Complications Post Surgery Flashcards
(42 cards)
1
Q
What complications can occur 0-5 days post surgery?
A
- haemorrhage
- urinary retention
- actelactasis > pneumonia
- infection e.g. UTI, cellulitis
- drug reaction
- delirium
- pain
2
Q
What complications can occur >5days post op?
A
- surgical site infection 5-10 days
- VTE 5-10 days
- wound dehiscence 10 days
- post op collection 5-20 days
3
Q
What complications can occur post general surgery?
A
- anastomotic leak
- incarcerated hernia
- bile duct injury/biliary peritonitis
- constipation
- intra-abdominal adhesions
- post op ileus
4
Q
What complications can occur post orthopaedic surgery?
A
- compartment syndrome
- nerve damage
- fat embolism
- acute limb ischaemia
5
Q
Post op vascular complications
A
- acute limb ischaemia
- ischamic reperfusion injury
- endovascular leak
6
Q
What complications can occur post urology surgery?
A
- AKI
- acute urinary retention
- UTI
- TURP syndrome
- ED
- retrograde ejaculation
7
Q
Features of anatomic leak
A
- 5-7 days post op
- worsening abdominal pain
- clinical features of sepsis
- tender abdomen
- yellow/orange gastric fluid in abdominal drain
8
Q
Investigations for anastomotic leak
A
- urgent bloods (FBC, U&Es. CRP, clotting, G+S, VBG, blood cultures)
- CT abdomen pelvis with IV contrast
9
Q
Management of anastomotic leak
A
- NBM
- broad spec abx as per guidelines
- IV fluid resuscitate
- surgical innervation if systemically unwell > laparotomy, washout + refashioning anastomosis
10
Q
Causes of post-op urinary retention
A
- drugs e.g. opioids, epidural/spinal anaesthesia
- pain > sympathetic activation > sphincter contraction
- mechanical e.g. blocker catheter, clot retention
11
Q
Management of post op urinary retention
A
- catheterise + strict fluid balance
- bladder irrigation using 3 day catheter if risk of clots
12
Q
What is wound dehiscence?
A
When a wound fails to heal > the wound reopens in the days after surgery
Typically 5-10 days after
13
Q
Types of wound dehiscence
A
- superficial: just the skin fails to heal but the rectus sheath remains intact
- full thickness: the rectus sheath fails to heal + bursts with protrusion of abdominal content
14
Q
What does superficial wound dehiscence often occur secondary to>?
A
- local infection
- poorly controlled diabetes
- poor nutritional status
15
Q
Risk factors of would dehiscence
A
- patient factors: age, diabetes, smoking, obesity, steroids, malnutrition
- intra-oeprative: emergency surgery, length of operation, poor surgical technique
- post operative: prolonged ventilation, poor tissue perfusion, haematoma/seroma formation, coughing
16
Q
What is wound dehiscence often proceed by?
A
Seroanginous (pink) discharge from the wound
17
Q
Management of wound dehiscence
A
- superficial: simple wound care
- if more extensive - vacuum assisted closure therapy
- full thickness:
- IV abx
- NBM
- cover wound with saline soaked gauze
- urgent return to theatre for surgical washout + debridement
18
Q
Prevention of wound dehiscence
A
- optimisation of co-morbidities pre op
- prompt treatment of surgical site infections
- avoid strenuous exercise
- adequate post op nutrition
19
Q
What management is needed if a wound has pink serous fluid coming from it?
A
Removal of skin clips/sutures at area of maximal leakage
Physical exam of the rectus sheath with finger or wound swab to check intact
20
Q
Presentation of VTE
A
- erythematous swollen calf
- pleuritic chest pain
- Haemoptysis
- SOB
- tachycardia
21
Q
Investigations of VTE
A
- bloods incl D dimer
- ECG
- ABG
- CXR
- US Doppler
- CTPA/VQ scan
22
Q
Management of VTE
A
- DOAC + continue for 3/6months
- thrombolysis
- embolectomy
23
Q
What is post-op ileus
A
Reduced/absent bowel peristalsis causing a pseudo-obstruction
24
Q
Risk factors of post op ileus
A
- age
- electrolyte derangement (K+, Mg, Phosphate)
- anti-cholinergic medications
- opioids
- peritoneal contamination
- intestinal resection
25
Features of post op ileus
- absolute constipation
- abdominal pain
- abdominal distension/bloating
- N+V
- lack of appetite
26
Investigations of post-op ileus
- bloods - FBC, U&Es, CRP, LFT, G+S, VBG (*met alkalosis*)
- AXR
- CT AP with IV contrasst
27
Management of post op ileus
- NBM
- IV fluids + correct electrolyte imbalances
- NG tube
- daily bloods
- encourage mobilisation
- reduce opiate analgesia
- regular antiemetics
28
What is the best antiemetic to use in post op ileus?
***Metoclopramide***
Rule out mechanical obstruction first
29
What is post op pyrexia most commonly due to (24 hours)
Physiological systemic inflammatory response
30
What are the 4 Ws in post op pyrexia?
- **Wind**: pulmonary causes *e.g. pneumonia, atelectasis)
- **Water**: UTI
- **Wound**: surgical site infections
- **What did we do?**: iatrogenic *e.g. drugs, lines, transfusions, procedures
31
Early causes of post-op pyrexia 0-5 days`
- normal physiological systemic inflammatory response
- blood transfusion reaction
- UTI
- cellulitis
- drug induced fever *e.g. abx, heparin*
- line infection
32
Late causes of post op pyrexia >5 days
- VTE
- hospital acquired pneumonia
- wound infection
- anastomotic leak
- intra-abdominal abscess
- C diff colitis
- endocarditis
33
What should be included in examination of a post op febrile patient?
- obs
- fluid chart
- notes + drug chart
- wound check
- systems exam
- lines/drains
34
Investigations of post-op pyrexia
- bloods - FBC, UEs, LFTs, G+S, clotting, ABG, blood culutre
- urine dip + MCS
- sputum culture
- wound swab for MCS
- line cultures
- CXR + CT
- ECG
35
Management of post op pyrexia
A-E assessment
Fluid resuscitate
Sepsis 6 is needed
Antipyretics *e.g. paracetamol*
36
What is important to ask in history of haemorrhage
Amount of blood
Route of blood loss
Colour of blood
37
Types of surgical haemorrhage
- **primary**: continuous bleeding starting during surgery
- **reactive**: bleeding at the end of surgery/early post op
- **secondary**: bleeding >24 hours post op - often due to infection
38
Management of haemorrhage
- resuscitate with fluids + blood if BP dropping
- G+S + clotting
- transfusion +/- TXA,platelets,FFP
- apply pressure if superficial
- major haemorrhage protocol 2222
- surgery
39
Presentation of pulmonary atelectasis
- dyspnoea
- dull lung bases
- hypoxaemia
- 48/72 hours post op
40
Management of pulmonary atelectasis
- O2
- adequate analgesia to aid coughing + deep inspiration
- **chest physiotherapy + deep breathing exercises**
- **position patient upright**
- if pneumonia is suspected - sputum culutre, ABG, CXR, treat as HAP - *co-amoxiclav*
41
When should atelectasis be suspected as a post op complication?
Dyspnoea + hypoxaemia 72 hours post op
42
What is atelectasis as post op complications due to?
Airways obstruction by bronchial secretions
