Post-operation complications (Surgery)

Question 1

What are some of the local complications post surgery?

1?

2?

3?

4?

5?

6?

7?

8?

Answer 1

1. Haemorrhage

2. Wound dehiscence

3.  Wound infection
4.  Scar formation
5.  Neuropraxia
6.  Delayed/non/mal-union

7. Return of original deformity

8. Iatrogenic deformity

Question 2

What factors could result in Haemorrhage?

 Poor 1?

 Poor 2?

 Ambulate patient 3?

4? therapy/thrombocytopaenia

 Result

5?

6?

7?

Answer 2

1. haemostasis
2. suturing technique
3. too early
4.  Anticoagulant

 Result

5. Wound dehiscence
6. Infection
7. Scaring

Question 3

Keloid scars

1? tumors

 Composed mainly of an 2?

 More common in 3?

Tx – 4?

Answer 3

1. Fibrotic
2. Overgrowth of either type III (early) or type I (late) collagen
3. Younger individuals and in highly pigmented individuals
4. Prevention, laser therapy

Question 4

Hypertrophic scar formation

definition 1?

Poor 2?

• Excessive use of 3?

Wound dehiscence

Infection

•Poor scar management

post-suture removal

Answer 4

1. Raised scars that do not grow beyond the boundaries of the original wound
2. suturing technique
3. electrocautery

Question 5

What are some signs of infection post-operatively?

 Abnormal 1?

2?

 Wound 3?

4?

Answer 5

1. post-op pain after 2-5 days
2.  Dolor, oedema & erythema
3. dehiscence/discharge
4. Cellulitis - local extension of inflammation

Question 6

How do you manage local infection?

 Drainage of 1?

removal of 2?

 Irrigation and wound dressing

 MCS +/- FBC

Answer 6

1. wound
2. some or all sutures

Question 7

What are the choices of antibiotics for local infections?

1?

(delayed allergy to penicillin) 2?

(immediate allergy to penicillin) 3?

Answer 7

1. Oral di/flucloxacillin 500 mg qid
2. Oral cephalexin 500 mg qid
3. Oral clindamycin 450mg tid

Question 8

What are some complications following matrixecotomies?

1?

2?

3?

Answer 8

1.  Hypergranulation tissue
2.  Infection
3.  Phenol􀁢burn

Question 9

What are the general complications post surgery?

Answer 9

1.  Extension of local infection
2.  Pulmonary

3. Cardiovascular

4. Neurological

5. Gastroenterological

6. Gynaecological

Question 10

 Lymphangitis 1?

 Lymphadenopathy 2?

 Fever/chills

Management 3?

Answer 10

1. Superficial erythematous streaking to popliteal or inguinal glands
2. inflammation/ tenderness of inguinal lymph glands
3.  Patient needs hospitalisation, ID consult and IV antibiotics

Question 11

What do pts with COPD have?

1?

2?

3?

Answer 11

1. Asthma
2. Emphysema
3. Chronic bronitis

Question 12

Atelectasis:

Collapse of the lung

Clinical presentation:

1?

2?

3?

4?

5?

Answer 12

1. +/- Elevated temp
2. Cough
3. Chest pain
4. Increased respiratory rate
5. Low O2 saturation

Question 13

What are the treatment options for Atelectasis?

Answer 13

1. Deep breathing/spirometry
2. Fizziotherapy
3. Antibiotics

Question 14

Atelectasis:

1? collapse

 Decreased perfusion ⇒ 2?

 Usually apparent 3?

 Dx – x-ray – affected lobe is 4?

Answer 14

1. Pulmonary
2. absorption alveolar gas ⇒collapse with accumulation of secretions and mucous
3. post-op day 2
4. opaque

Question 15

Pneumonia

􀁢Post-op chest􀁠

Characteristics 1?

2? of all operations

Predisposing factors 3?

Investigations 4?

Treatment 5?

Answer 15

1. Segmental atelectasis, hypoxaemia, elevated temp, purulent sputum
2. 5%
3. age, smoking, obesity, preexisting lung disease
4. chest x-ray, MC&S
5. fizziotherapy, antibiotics

Question 16

What does the red arros show?

Answer 16

Unhealthy, white = congestion

Question 17

Pulmonary Embolism

Blockage of 1? , usually originating as 2?

 Up to 10% 3?

 10% pts die 4?

Answer 17

1. pulmonary artery by embolis
2. DVT in pelvis or legs (90%)
3. post-op hospital deaths
4. within 1 hr with up to 20% dying subsequently

Question 18

What are the sign/symptoms of pulmonary embolism?

Answer 18

1. Sudden pleuritic pain
2. tachypnoea
3. haemoptysis,
4. fever, anxiety, wheeze, cough.

Question 19

What are the treatment options for pulmonary embolism?

1?

2?

3?

Answer 19

1. Medical emergency
2. Fibrinolytic drugs
3. Embolectomy

Question 20

Deep vein thrombosis:

Present in 1? hospital deaths at autopsy

0.4% after childbirth

12-15% soft tissue injury to lower limbs

50% elderly after fracture femur/pelvis

2? all foot and ankle cases

Answer 20

1. 1. 25%
2. 0.25%

Question 21

DVT

Common after 1? operations

Possible outcomes:

2?

3?

4?

Answer 21

1. lower abdominal, pelvic and lower extremity
2. Fibrosis of clot with formation of collateral circulation
3. Pulmonary emboli
4. Post DVT syndrome

Question 22

What is the Virchow’s triad for DVT?

1?

2?

3?

Answer 22

1. Hypercoagulation
2. Damage to vessel wall
3. Venous stasis

Question 23

What are the minor risk factors for DVT/PE?

1?

2?

3?

4?

5?

6?

Answer 23

1. Immobility/bed rest
2.  Increasing age
3.  Minor surgery

4. Obesity

5. Varicose veins

6. Smoking

Question 24

What are moderate risk factors for VTE?

1?

2?

3?

4?

5?

6?

7?

Answer 24

1. Malignancy

2. Heart or respiratory failure

3.  Oestrogens (HRT or OCP)
4.  Previous DVT/PE

5. Most non-major surgery

6. Thrombophilia

7. Postpartum period

Question 25

What are major risk factors for VTE? 1? 2? 3? 4?

Answer 25

1.  Major fractures (especially hip) 2.  Hip or knee joint replacement 3. Other major surgery/trauma 4. Spinal cord injury

Question 26

What's the management option for DVT prophylaxis?  Mechanical methods: 1?  reduce risk of DVT by 2? 3? Pharmacological methods: 4?

Answer 26

1. Graduated compression stockings 2. ~50% 3. Intermittent pneumatic compression devices 4. Unfractionated heparin (UFH) and Low Molecular Weight Heparin (LMWH) both highly effective/ Aspirin: small but significant reduction in risk (375mg/day)

Question 27

**Heparin use:**  For all high risk cases: 1?  Consider for moderate & lower risk cases as well

Answer 27

1. LMW heparin  enoxaparin (Clexane) 20-40mg daily, or  daltepain (Fragmin) 2,500-5,000 units daily, or Unfractionated heparin 5,000 units bd

Question 28

1. The difference between Low molecular weight heparin and unfractioned Heparin? 2.  **Advantage of LMWH?** **3.  Advantage of UFH?​**

Answer 28

1. Little difference in terms of efficacy (DVT prevention) or safety (risk of bleeding) 2. Better dose-response relationship /More convenient (once daily)/ Less thrombocytopaenia/ Cost effective 3. Short acting and can be reversed with protamine

Question 29

What are the **contraindications** to anticoagulant prophylaxis? 1? 2? 3? 4? 5?

Answer 29

1. Active bleeding 2. History of GI bleeding 3. High risk of bleeding (eg low platelet count) 4. Severe hepatic disease 5. Adverse reaction to heparin

Question 30

What's the contraindications to **mechanical prophylaxis**? 1? 2? 3? 4?

Answer 30

1. Severe peripheral arterial disease 2. Recent skin graft 3. Severe peripheral neuropathy 4. Severe leg deformity

Question 31

Podiatric Surgical management:  Aim to keep patient 1?  Austin better than 2?  Caution with 3?  Compressive bandaging rather than 4?

Answer 31

1. ambulating 2. CBWO 3. extended use of K-wires 4. B-K casts

Question 32

What is **Pseudo-membranous enterocolitis**? Uncommon fulminating bowel infection due to emergence of resistant strains of 1? Sings and Symptoms 2? Treatment 3?

Answer 32

1. Staphlococcus or Clostridium difficile 2. Severe diarrheoa/ Abdominal distention/ Hypotension/ Shock 3. Avoid prolonged antibiotic use Especially di/flucloxacillin/ Fluid replacement/ Vancomycin or metranidazole