Flashcards in GI Misc. - Postoperative Complications Deck (56)
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1
What are the 2 possible types of postoperative complications?
General (any operation)
Specific (this operation)
2
Main CV complications of any operation?
Haemorrhage
MI (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:
Tachycardia
hypotension
oliguria (poor urine output)
5
Haemorrhage prevention? (3)
Meticulous technique in surgery
Avoidance of sepsis
Correction of coagulation disorders
6
2 types of MI related to surgery?
Post-operative
Peri-operative
7
What causes an increased risk of having a peri-post-operative MI?
Severe angina
Previous MI
8
What are the symptoms of a peri/post-operative MI?
Often silent when peri-operative
cardiac failure/ cardiogenic shock
Arrhythmias
9
How to prevent a peri/post-operative MI?
Delay surgery after MI
Avoidance of preoperative hypotension
Correction of ischaemic heart disease
10
What are the risk factors for a DVT?
Age > 40
Previous DVT
major surgery
Obesity
malignancy
11
What causes a DVT during/ after surgery?
Immobility during surgery
Hyper-coagulable state
12
How does a DVT present?
Low grade fever (5-14 days)
Unilateral ankle swelling
Calf or thigh tenderness
Increased leg diameter
Shiny skin
13
Investigations for a DVT?
D-dimer test (good rule-out test)
If D-dimer abnormal, Doppler US
Venography
(if you think they have a DVT, start them on heparin)
14
How to prevent DVT?
Compression stockings
Low-dose subcutaneous heparin
Early mobilisation
15
3 main respiratory surgery complications?
Atelectasis
Penumonia
PE
16
Atelectasis?
Collapse of lung tissue which leads to infection (pneumonia)
17
How does surgery lead to atelectasis/ pneumonia?
Anaesthesia = increases secretion, inhibits cilia
Postoperative pain = inhibits coughing
Aspiration = stomach contents
18
How does a post-operative chest infection present?
Low grade fever (0-2 days)
High grade fever (4-10 days)
Dyspnoea
Productive cough
Confusion (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?
Tachypnoea
Dyspnoea
Confusion (due to hypoxia)
Pleuritic pain
Haemoptysis
Cardiopulmonary 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 scan
Usually perform a CTPA if you suspect a large PE
25
Prevention of PE?
Same way as we prevent DVT:
Compression stockings
Early mobilisation
If DVT, anticoagulation
Low-dose subcutaneous heparin
26
Complications of GI surgery?
Ileus
Anastomotic dehiscence
Adhesions
27
What is ileus?
Paralysis of intestinal motility
28
What is ileus caused by?
Handling of bowel
Peritonitis
Retroperitoneal injury
Immobilisation
Hypolalaemia
Drugs
29
How does a patient with ileus present?
Vomiting
Abdominal distension
Dehydration
Silent abdomen
30
