GI Misc. - Postoperative Complications Flashcards by Sophia White

What are the 2 possible types of postoperative complications?

General (any operation)

Specific (this operation)

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Main CV complications of any operation?

Haemorrhage
MI (mainly if the patient has history of this)
DVT

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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)

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How does a haemorrhage present? (3)

Normally can’t see it as inside a cavity:
Tachycardia
hypotension
oliguria (poor urine output)

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Haemorrhage prevention? (3)

Meticulous technique in surgery
Avoidance of sepsis
Correction of coagulation disorders

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2 types of MI related to surgery?

Post-operative

Peri-operative

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

Severe angina

Previous MI

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

Often silent when peri-operative
cardiac failure/ cardiogenic shock
Arrhythmias

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How to prevent a peri/post-operative MI?

Delay surgery after MI
Avoidance of preoperative hypotension
Correction of ischaemic heart disease

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What are the risk factors for a DVT?

Age > 40
Previous DVT
major surgery
Obesity
malignancy

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What causes a DVT during/ after surgery?

Immobility during surgery

Hyper-coagulable state

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How does a DVT present?

Low grade fever (5-14 days)
Unilateral ankle swelling
Calf or thigh tenderness
Increased leg diameter
Shiny skin

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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)

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How to prevent DVT?

Compression stockings
Low-dose subcutaneous heparin
Early mobilisation

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3 main respiratory surgery complications?

Atelectasis
Penumonia
PE

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Atelectasis?

Collapse of lung tissue which leads to infection (pneumonia)

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How does surgery lead to atelectasis/ pneumonia?

Anaesthesia = increases secretion, inhibits cilia
Postoperative pain = inhibits coughing
Aspiration = stomach contents

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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)

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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

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What causes a PE?

A DVT (same risk factors as a DVT)

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How does a PE present?

Tachypnoea
Dyspnoea
Confusion (due to hypoxia)
Pleuritic pain
Haemoptysis
Cardiopulmonary arrest

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

Inhaled gaseous radionuclide

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

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Injection of albumin tagged with radionuclide

What are the test for a PE?

Study These Flashcards

Abnormal V/Q scan

Usually perform a CTPA if you suspect a large PE

Prevention of PE?

``` Same way as we prevent DVT: Compression stockings Early mobilisation If DVT, anticoagulation Low-dose subcutaneous heparin ```

Complications of GI surgery?

Ileus Anastomotic dehiscence Adhesions

What is ileus?

Paralysis of intestinal motility

What is ileus caused by?

``` Handling of bowel Peritonitis Retroperitoneal injury Immobilisation Hypolalaemia Drugs ```

How does a patient with ileus present?

Vomiting Abdominal distension Dehydration Silent abdomen

How is an ileus prevented?

Minimal operative trauma Laparoscopy Avoidance of intra-abdominal sepsis

What is anastomotic dehiscence?

Breakdown of anastomosis: - intestinal - vascualar - urological

What causes anastomotic dehiscence?

Poor technique Poor blood supply Tension on anastomosis

How does an intestinal anastomotic dehiscence present?

Periotnitis Abscess Ileus Fistula

How does a vascular anastomotic dehiscence present?

bleeding/ haematoma

How does a urological anastomotic dehiscence present?

Leakage of urine/ urinoma

prevention of an anastomotic dehiscence?

Good technique Good blood supply No 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 bowel Bowel to abdominal wall and other structures Lung to chest wall

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

Asymptomatic

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

``` Vomiting Pain Distension Constipation (depends on location) ```

Prevention of adhesions?

No power on gloves Avoidance of infection Laparoscopic surgery Sodium hyaluronidate (slightly decreases the risk of adhesion formation)

What are the 3 main complications regarding wounds?

Infection Dehiscence Hernia

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?

Trauma patients

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) Redness Pain Swelling Discharge ```

Prevention of wound infection?

``` Pre-op preparation (e.g. bowel prep) Skin cleansing Aseptic technique Avoidance of contamination Prophylactic antibiotics (single dose) ```

What are the main urinary complications?

Acute retention of urine Urinary tract infection urethral structure Acute renal failure

What are the main neurological complicaitons?

Confusion Stroke Peripheral 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) Oversedation Sepsis Electrolyte imbalance Stroke Hyper or hypoglycaemia Alcohol or tranquilliser withdrawl ```

Confusion presentation?

Disorientation (time and place) Paranoia Hallucinations

Confusion prevention?

Maintain oxygenation Avoid dehydration Avoid sepsis Send home as soon as possible!

How to minimise complications and their effect?

Patient selection and their effect Careful surgery Constant 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

What are the 3 components of ERAS pathway?

Pre-op Peri-op Post-op

GI Misc. - Postoperative Complications Flashcards

(56 cards)