GI Misc. 7 - GI surgery complicaitons Flashcards Preview

1st Year - Gastroenterology > GI Misc. 7 - GI surgery complicaitons > Flashcards

Flashcards in GI Misc. 7 - GI surgery complicaitons Deck (56):
1

What are the 2 possible types of postoperative complications?

General (any operation)Specific (this operation)

2

Main CV complications of any operation?

HaemorrhageMI (mainly if the patient has history of this)DVT

3

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)

4

How does a haemorrhage present? (3)

Normally can't see it as inside a cavity:Tachycardiahypotensionoliguria (poor urine output)

5

Haemorrhage prevention? (3)

Meticulous technique in surgeryAvoidance of sepsisCorrection of coagulation disorders

6

2 types of MI related to surgery?

Post-operativePeri-operative

7

What causes an increased risk of having a peri-post-operative MI?

Severe anginaPrevious MI

8

What are the symptoms of a peri/post-operative MI?

Often silent when peri-operativecardiac failure/ cardiogenic shockArrhythmias

9

How to prevent a peri/post-operative MI?

Delay surgery after MIAvoidance of preoperative hypotensionCorrection of ischaemic heart disease

10

What are the risk factors for a DVT?

Age > 40Previous DVTmajor surgeryObesitymalignancy

11

What causes a DVT during/ after surgery?

Immobility during surgeryHyper-coagulable state

12

How does a DVT present?

Low grade fever (5-14 days)Unilateral ankle swellingCalf or thigh tendernessIncreased leg diameterShiny skin

13

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)

14

How to prevent DVT?

Compression stockingsLow-dose subcutaneous heparinEarly mobilisation

15

3 main respiratory surgery complications?

AtelectasisPenumoniaPE

16

Atelectasis?

Collapse of lung tissue which leads to infection (pneumonia)

17

How does surgery lead to atelectasis/ pneumonia?

Anaesthesia = increases secretion, inhibits ciliaPostoperative pain = inhibits coughingAspiration = stomach contents

18

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)

19

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

20

What causes a PE?

A DVT (same risk factors as a DVT)

21

How does a PE present?

TachypnoeaDyspnoeaConfusion (due to hypoxia)Pleuritic painHaemoptysisCardiopulmonary arrest

22

What type of radionucletide is used in the ventilation part of the V/Q scan?

Inhaled gaseous radionuclide

23

What type of radio nucleotide is used in the perfusion part of the VIQ scan?

Injection of albumin tagged with radionuclide

24

What are the test for a PE?

Abnormal V/Q scanUsually perform a CTPA if you suspect a large PE

25

Prevention of PE?

Same way as we prevent DVT:Compression stockingsEarly mobilisationIf DVT, anticoagulation Low-dose subcutaneous heparin

26

Complications of GI surgery?

IleusAnastomotic dehiscence Adhesions

27

What is ileus?

Paralysis of intestinal motility

28

What is ileus caused by?

Handling of bowelPeritonitisRetroperitoneal injuryImmobilisation HypolalaemiaDrugs

29

How does a patient with ileus present?

VomitingAbdominal distensionDehydrationSilent abdomen

30

How is an ileus prevented?

Minimal operative traumaLaparoscopyAvoidance of intra-abdominal sepsis

31

What is anastomotic dehiscence?

Breakdown of anastomosis:-intestinal-vascualar-urological

32

What causes anastomotic dehiscence?

Poor techniquePoor blood supplyTension on anastomosis

33

How does an intestinal anastomotic dehiscence present?

PeriotnitisAbscessIleusFistula

34

How does a vascular anastomotic dehiscence present?

bleeding/ haematoma

35

How does a urological anastomotic dehiscence present?

Leakage of urine/ urinoma

36

prevention of an anastomotic dehiscence?

Good techniqueGood blood supplyNo tension

37

What causes the deposition of fibrous tissue?

Any operation due to a combination of the inflammatory response and ischaemia

38

Where can adhesions form in surgery?

Bowel to bowelBowel to abdominal wall and other structuresLung to chest wall

39

What are the symptoms of a adhesion to the chest wall?

Asymptomatic

40

What are the symptoms of an intestinal obstruction (due to adhesions)?

VomitingPainDistensionConstipation(depends on location)

41

Prevention of adhesions?

No power on glovesAvoidance of infectionLaparoscopic surgerySodium hyaluronidate (slightly decreases the risk of adhesion formation)

42

What are the 3 main complications regarding wounds?

InfectionDehiscenceHernia

43

What tends to be the source of the bacteria for infection of a wound?

Intestinal contetns(Unusual to be caused by external environement)

44

What type of patients tend to get an exogenous infection?

Trauma patients

45

What type of patients tend to get an endogenous infection?

Intestinal surgery patients

46

What are the symptoms of a wound infection?

Pyrexia (5-8 days)RednessPainSwellingDischarge

47

Prevention of wound infection?

Pre-op preparation (e.g. bowel prep)Skin cleansingAseptic techniqueAvoidance of contaminationProphylactic antibiotics (single dose)

48

What are the main urinary complications?

Acute retention of urineUrinary tract infectionurethral structureAcute renal failure

49

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

50

Causes of confusion?

Hypoxia (most common cause - chest infection, PE, MI)OversedationSepsisElectrolyte imbalanceStrokeHyper or hypoglycaemiaAlcohol or tranquilliser withdrawl

51

Confusion presentation?

Disorientation (time and place)ParanoiaHallucinations

52

Confusion prevention?

Maintain oxygenationAvoid dehydrationAvoid sepsisSend home as soon as possible!

53

How to minimise complications and their effect?

Patient selection and their effectCareful surgeryConstant vigilance

54

What does ERAS stand for?

Enhanced Recovery affter surgery

55

What are the objectives of ERAS?

To minimise post-operativecomplicaitons and return patient to normality ASAP by promoting pain control, GI function, mobility

56

What are the 3 components of ERAS pathway?

Pre-opPeri-opPost-op