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Phase 2 - General Surgery Placement > Gastrointestinal Post-Op Complications > Flashcards

Gastrointestinal Post-Op Complications Flashcards

1
Q

what are the common early post-op GI complications?

A
  • ileus
  • malabsorption
  • post-op nausea and vomiting
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2
Q

what is an ileus?

A

decrease or complete arrest in gut motility following surgery

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3
Q

what are the risk factors for an ileus?

A
  • intra-abdominal surgery
  • opioid analgesia
  • stress response
  • sepsis
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4
Q

what are the clinical presentation of a post-operative ileus?

A
  • failure to pass flatus or faeces
  • sensation of bloating or distension
  • nausea and vomiting
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5
Q

what are the clinical findings of a post-operative ileus?

A
  • abdominal distension

- absent bowel sounds

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6
Q

what investigations can be done in a suspected post-op ileus?

A
  • routine bloods

- CT scan of the abdo pelvis to confirm diagnosis

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7
Q

what is the management for a post-op ileus?

A
  • encourage mobilisation
  • reduce opiate analgesia
  • using an NG tube to drain bowel contents
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8
Q

what can be done to prevent a post-op ileus?

A
  • minimise intra-operative intestinal handling
  • avoid fluid overload as can cause intestinal oedema
  • minimise opiate use
  • encourage early mobilisation
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9
Q

what is an anastomotic leak?

A

a leak of luminal contents from a surgical join

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10
Q

why is it so important to identify an anastomotic leak?

A

the longer it is left untreated, the more chance of contamination of the abdomen by the luminal contents

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11
Q

what is the worst complication of an anastomotic leak?

A

sepsis

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12
Q

true or false: a patient who is deteriorating after surgery is considered to have an anastomotic leak until proven otherwise

A

true.

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13
Q

what are the patient risk factors for an anastomotic leak?

A
  • immunosuppressed
  • smoking or alcohol excess
  • diabetic
  • obesity or malnutrition
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14
Q

what are the surgical risk factors for an anastomotic leak?

A
  • emergency surgery
  • loner intra-operative time
  • peritoneal contamination
  • oesophageal-gastric or rectal anastomoses
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15
Q

what are the clinical features of an anastomotic leak?

A

abdominal pain and fever presenting 5 to 7 days post operatively

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16
Q

what are the clinical signs of an anastomotic leak?

A

pyrexia
tachycardia
signs of peritonism (severe pain and swelling of the abdomen)

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17
Q

what investigations should be done in a patient with a suspected anastomotic leak?

A

CT abdo-pelvis which will show if there are any extra-luminal contents
Blood test: FBC, U&Es, CRP, LFTs, clotting screen, G&S and X-match

18
Q

how would you initially manage a patient with an anastomotic leak?

A

put the patient on NBM status and begin broad spectrum antibiotic cover
begin IV fluid therapy and monitor fluid balance with catheter insertion

19
Q

what is considered the definitive management of a minor anastomotic leak?

A

can be managed conservatively:
using IV antibiotics if small
percutaneous drainage if leak is >5cm

20
Q

what is considered definitive management of a major anastomotic leak?

A

if the patient is septic or has multiple collections then an exploratory laparotomy is done - to washout with drain insertion

21
Q

true or false: a colo-rectal anastomosis should be treated with a stoma

A

true.

22
Q

what are bowel adhesions?

A

fibrous bands of scar tissue, most commonly due to previous surgery or intra-abdo inflammation

23
Q

true or false: bowel adhesions are the most common cause of small bowel obstruction

A

true.

24
Q

true or false: bowel adhesions tend to asymptomatic

A

true.

25
Q

what are the major complications of bowel adhesions?

A

obstruction, female infertility, chronic pelvic pain

26
Q

what is the management for bowel obstruction caused by adhesions?

A

if uncomplicated:
treat conservatively using an NG tube to decompress
patient is also kept NBM and given IV fluids and analgesia

27
Q

what is the surgical management for bowel obstruction caused by adhesions?

A

adhesiolysis is only done if patient shows signs of ischaemia or perforation, or if conservative treatment failed.
it is also only done on adhesions causing the obstruction

28
Q

what is an incisional hernia?

A

protrusion of the contents of the abdominal cavity through a previously made incision

29
Q

why does an incisional hernia occur?

A

disruption of the continuity of the anterior abdominal wall muscles by a surgical incision results in structural weakness.
an increase in intra-abdominal pressure allows the abdominal contents to herniate through this weakness

30
Q

what are the risk factors for an incisional hernia?

A
  • emergency surgery
  • wound and incision (midline) type
  • obesity
  • wound infection
  • age
  • pregnancy
  • smoking
  • connective tissue disorders
31
Q

what are the clinical features of an incisional hernia?

A

non pulsatile, reducible, soft and non-tender swelling at or near the site of a previous surgical wound

32
Q

what are the clinical features of an incarcerated incisional hernia?

A

painful, tender and erythematous

33
Q

what would you find on examination of an incisional hernia?

A

palpable mass which may be reducible

if ischaemic: there may be rebound tenderness or guarding

34
Q

what investigations would you do in a patient with a suspected incisional hernia?

A

diagnosis is made on clinical basis however USS or CT can be used to investigate

35
Q

how would you manage an incisional hernia?

A

if asymptomatic: manage conservatively

if symptomatic: surgery is indicated

36
Q

what is the clinical definition of constipation?

A

< 3 bowel movements a week, often with hard, dry stool, that may be difficult to pass

37
Q

what are the causes of post-op constipation?

A
  • physiological e.g. low fibre diet, low fluid intake
  • iatrogenic e.g. medications like opioids
  • pathological such as bowel obstruction
  • functional such as painful defecation
38
Q

what are the clinical presentation of post-op constipation?

A

lower abdominal pain

if severe can present with abdo distension, nausea and vomiting, loss of appetite

39
Q

what are the clinical signs of post-op constipation?

A

a DRE is done to assess degree of faecal impaction

40
Q

what investigations are done in a suspected post-op constipation?

A

usually made on a clinical diagnosis

imaging is only done if bowel obstruction is suspected

41
Q

what is the management for a post-op constipation?

A

conservatively managed with laxatives

if resistant additional therapy can be done as manual evacuation or an enema

42
Q

what preventative measures can be given for post-op constipation?

A
  • opioid analgesia should be avoided

- prophylactic stimulant laxatives should be used if needed

Phase 2 - General Surgery Placement (14 decks)

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