Post-Op Complications of Abdominal Sx

Question 1

you should check _____ daily for evidence of: (4)

Answer 1

twice daily:
- swelling
- pain
- redness
- discharge or dehiscence

Question 2

what does dehiscence mean

Answer 2

breakdown

Question 3

when do we remove skin sutures

Answer 3

10-14d

Question 4

what are 6 examples of incisional complications

Answer 4

1) inflammation
2) infection
3) hematoma
4) seromas
5) evisceration
6) herniation

Question 5

how does evisceration differ from herniation

Answer 5

evisceration: organs coming completely out of the body

herniation: organs out of abdominal cavity but contained within skin

Question 6

T/F post-op inflammation always indicates infection

Answer 6

F

Question 7

at what point post-op do we assume the inflammation has progressed to infection

Answer 7

a couple of days have passed and you still see lots of inflammation

Question 8

with post-op inflammation, when should you apply a cold pack and when should you apply a warm pack

Answer 8

cold: first few days
warm: seroma

Question 9

what can we do to help patients with hemorrhage or hematoma post-op

Answer 9

pressure bandage/resorption

Question 10

if marked hemorrhage, what follow-up should we be doing

Answer 10

monitoring PCV

Question 11

scrotal hematomas are typically caused by poorly ligated ____________ vessels, NOT _________ vessels

Answer 11

tunic; testicular (they would cause hemoabdomen)

Question 12

T/F you should apply a cold pack to a hematoma

Answer 12

F; warm pack

Question 13

what is the concern with hematomas

Answer 13

they are a great medium for bacterial growth and can become infected

Question 14

when do we most often see seromas (what timeline)

Answer 14

delayed (>5 days)

Question 15

how do seromas typically present

Answer 15

fluctuant swelling that is non-painful and tends to be gravity dependent

Question 16

how do we confirm seromas vs hematomas

Answer 16

on ultrasound will appear serosanguinous; aspiration will show pale yellow-red fluid

Question 17

how do we treat seromas

Answer 17

• drain as much as possible and bandage
• warm pack
• can drain or close dead space if recurrence

Question 18

what do you do in the case of tension and breakdown/dehiscence/skin necrosis

Answer 18

remove dead tissue, clean, bandage and let heal by second intention

Question 19

what is a location that is prone to infection after surgery and why

Answer 19

toes/paws; moist, hard to prep, non-sterile location

Question 20

with what post-op complication do we typically need to intervene

Answer 20

infection and breakdown

Question 21

how do we fix infected wounds/breakdown of wounds from best case to worst case

Answer 21

• clean, examine, +/- bandage
• remove sutures, lavage, let heal by second intention
• surgical debridement, lavage +/- closure

Question 22

what are two considerations with all infected wounds

Answer 22

whether to culture and whether to give antibiotics

Question 23

what is the definition of evisceration

Answer 23

herniation of peritoneal content through the body wall with exposure of the abdominal viscera

Question 24

what is the first sign of evisceration

Answer 24

swelling and serosanguinous discharge

Question 25

what are the 4 most common causes of evisceration

Answer 25

1) poor integration of the external rectus fascia in each suture bite 2) suture breakage 3) knot slippage or untying 4) suture cutting through tissues

Question 26

what is the most common comorbidity associated with dehiscence

Answer 26

infected wound

Question 27

along what timeline do we typically see evisceration and dehiscence

Answer 27

within first 5-7 days

Question 28

what typically eviscerates

Answer 28

omentum and intestines

Question 29

what are the 2 most common causes of evisceration

Answer 29

poor apposition of suture layers or poor suture technique

Question 30

what are three complications of evisceration

Answer 30

- serious self-mutilation - hemorrhage - shock

Question 31

T/F most evisceration occurs in cat spays due to the fact that this surgery specifically predisposes to infection and breakdown

Answer 31

F: most common in spays but due to how often the procedure is performed rather than a complication

Question 32

T/F evisceration is commonly contaminated with dirt, leaves, litter

Answer 32

T

Question 33

how do we treat/correct evisceration

Answer 33

- cover with saline sterile towels and lightly bandage - stabilize patient - antibiotics - anesthetize asap: lavage, resect, lavage, close

Question 34

T/F survival is very high after evisceration post-OHE

Answer 34

T

Question 35

when do we typically see herniation

Answer 35

10-21 days post-op (whereas evisceration is within the first 5-6 days)

Question 36

what causes herniation

Answer 36

when the linea breaks down after skin healing has occurred

Question 37

what is the risk with herniation

Answer 37

organ entrapment and ischemia

Question 38

often the actual linea site is what size

Answer 38

small; < 1cm

Question 39

in what case do we see a small hernia that grows with time

Answer 39

if it includes fat, which then grows externally as the patient gains weight

Question 40

what are the two types of peritonitis

Answer 40

chemical and septic

Question 41

how do we treat peritonitis

Answer 41

- treat problem - lavage - leave drains

Question 42

what is the most common item lost in surgery (inside the patient!)

Answer 42

sponges (then needles, then instruments)

Question 43

what are 3 ways to ensure you do not leave anything inside the patient

Answer 43

- counting sponges in and out - radioopaque gauze - having a surgical checklist