Flashcards in GI Misc. 7 - GI surgery complicaitons Deck (56)
What are the 2 possible types of postoperative complications?
General (any operation)Specific (this operation)
Main CV complications of any operation?
HaemorrhageMI (mainly if the patient has history of this)DVT
What are the 2 types of haemorrhages - postoperative complications?
Reactionary (immediately pos-operative e.g. if not tied vessels properly)Secondary (related to infection - 5-10 days post-surgery)
How does a haemorrhage present? (3)
Normally can't see it as inside a cavity:Tachycardiahypotensionoliguria (poor urine output)
Haemorrhage prevention? (3)
Meticulous technique in surgeryAvoidance of sepsisCorrection of coagulation disorders
2 types of MI related to surgery?
What causes an increased risk of having a peri-post-operative MI?
Severe anginaPrevious MI
What are the symptoms of a peri/post-operative MI?
Often silent when peri-operativecardiac failure/ cardiogenic shockArrhythmias
How to prevent a peri/post-operative MI?
Delay surgery after MIAvoidance of preoperative hypotensionCorrection of ischaemic heart disease
What are the risk factors for a DVT?
Age > 40Previous DVTmajor surgeryObesitymalignancy
What causes a DVT during/ after surgery?
Immobility during surgeryHyper-coagulable state
How does a DVT present?
Low grade fever (5-14 days)Unilateral ankle swellingCalf or thigh tendernessIncreased leg diameterShiny skin
Investigations for a DVT?
D-dimer test (good rule-out test)If D-dimer abnormal, Doppler USVenography(if you think they have a DVT, start them on heparin)
How to prevent DVT?
Compression stockingsLow-dose subcutaneous heparinEarly mobilisation
3 main respiratory surgery complications?
Collapse of lung tissue which leads to infection (pneumonia)
How does surgery lead to atelectasis/ pneumonia?
Anaesthesia = increases secretion, inhibits ciliaPostoperative pain = inhibits coughingAspiration = stomach contents
How does a post-operative chest infection present?
Low grade fever (0-2 days)High grade fever (4-10 days)DyspnoeaProductive coughConfusion (due to hypoxia)
How to prevent a chest infection?
Stopping smoking (even for a couple of days prior to surgery)Adequate analgesia (blocks pain = coughing, stronger analgesics can cause respiratory suppression)Physiotherapy
What causes a PE?
A DVT (same risk factors as a DVT)
How does a PE present?
TachypnoeaDyspnoeaConfusion (due to hypoxia)Pleuritic painHaemoptysisCardiopulmonary arrest
What type of radionucletide is used in the ventilation part of the V/Q scan?
Inhaled gaseous radionuclide
What type of radio nucleotide is used in the perfusion part of the VIQ scan?
Injection of albumin tagged with radionuclide
What are the test for a PE?
Abnormal V/Q scanUsually perform a CTPA if you suspect a large PE
Prevention of PE?
Same way as we prevent DVT:Compression stockingsEarly mobilisationIf DVT, anticoagulation Low-dose subcutaneous heparin
Complications of GI surgery?
IleusAnastomotic dehiscence Adhesions
What is ileus?
Paralysis of intestinal motility
What is ileus caused by?
Handling of bowelPeritonitisRetroperitoneal injuryImmobilisation HypolalaemiaDrugs
How does a patient with ileus present?
VomitingAbdominal distensionDehydrationSilent abdomen
How is an ileus prevented?
Minimal operative traumaLaparoscopyAvoidance of intra-abdominal sepsis
What is anastomotic dehiscence?
Breakdown of anastomosis:-intestinal-vascualar-urological
What causes anastomotic dehiscence?
Poor techniquePoor blood supplyTension on anastomosis
How does an intestinal anastomotic dehiscence present?
How does a vascular anastomotic dehiscence present?
How does a urological anastomotic dehiscence present?
Leakage of urine/ urinoma
prevention of an anastomotic dehiscence?
Good techniqueGood blood supplyNo tension
What causes the deposition of fibrous tissue?
Any operation due to a combination of the inflammatory response and ischaemia
Where can adhesions form in surgery?
Bowel to bowelBowel to abdominal wall and other structuresLung to chest wall
What are the symptoms of a adhesion to the chest wall?
What are the symptoms of an intestinal obstruction (due to adhesions)?
VomitingPainDistensionConstipation(depends on location)
Prevention of adhesions?
No power on glovesAvoidance of infectionLaparoscopic surgerySodium hyaluronidate (slightly decreases the risk of adhesion formation)
What are the 3 main complications regarding wounds?
What tends to be the source of the bacteria for infection of a wound?
Intestinal contetns(Unusual to be caused by external environement)
What type of patients tend to get an exogenous infection?
What type of patients tend to get an endogenous infection?
Intestinal surgery patients
What are the symptoms of a wound infection?
Pyrexia (5-8 days)RednessPainSwellingDischarge
Prevention of wound infection?
Pre-op preparation (e.g. bowel prep)Skin cleansingAseptic techniqueAvoidance of contaminationProphylactic antibiotics (single dose)
What are the main urinary complications?
Acute retention of urineUrinary tract infectionurethral structureAcute renal failure
What are the main neurological complicaitons?
ConfusionStrokePeripheral nerve lesions (ulnar, radial, sciatic, common peroneal nerves are easily compressed/ stretched) - be careful of positioning patients in surgery
Causes of confusion?
Hypoxia (most common cause - chest infection, PE, MI)OversedationSepsisElectrolyte imbalanceStrokeHyper or hypoglycaemiaAlcohol or tranquilliser withdrawl
Disorientation (time and place)ParanoiaHallucinations
Maintain oxygenationAvoid dehydrationAvoid sepsisSend home as soon as possible!
How to minimise complications and their effect?
Patient selection and their effectCareful surgeryConstant vigilance
What does ERAS stand for?
Enhanced Recovery affter surgery
What are the objectives of ERAS?
To minimise post-operativecomplicaitons and return patient to normality ASAP by promoting pain control, GI function, mobility