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