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Flashcards in Post-operation complications (Surgery) Deck (32):
1

 

What are some of the local complications post surgery?

1?

2?

3?

4?

5?

6?

7?

8?

 

 

 

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

2

 

What factors could result in Haemorrhage?

 Poor 1?

 Poor 2?

 Ambulate patient 3?

4? therapy/thrombocytopaenia

 Result

5?

6?

7?

 

1. haemostasis

2. suturing technique

3. too early

4. Anticoagulant

 Result

5. Wound dehiscence

6. Infection

7. Scaring

3

Keloid scars

1? tumors

 Composed mainly of an 2?

 More common in 3?

Tx – 4?

 

 

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

4

Hypertrophic scar formation 

definition 1?

Poor 2?

• Excessive use of 3?

Wound dehiscence

 Infection

•Poor scar management

post-suture removal

 

 

1. Raised scars that do not grow beyond the boundaries of the original wound

2. suturing technique

3. electrocautery

 

 

5

 

What are some signs of infection post-operatively?

 Abnormal 1?

2?

 Wound 3?

4?

 

1.  post-op pain after 2-5 days

2.  Dolor, oedema & erythema

3.  dehiscence/discharge

4.  Cellulitis - local extension of inflammation

6

How do you manage local infection?

 Drainage of 1?

removal of 2?

 Irrigation and wound dressing

 MCS +/- FBC

 

 

1. wound 

2. some or all sutures

7

 

What are the choices of antibiotics for local infections?

1?

(delayed allergy to penicillin) 2?

(immediate allergy to penicillin) 3?

 

 

1. Oral di/flucloxacillin 500 mg qid

2. Oral cephalexin 500 mg qid

3. Oral clindamycin 450mg tid

8

 

What are some complications following matrixecotomies?

1?

2?

3?

 

 

 

1. Hypergranulation tissue

2. Infection

3. Phenol􀁢burn

9

 

What are the general complications post surgery?

 

 

1. Extension of local infection

2. Pulmonary

3. Cardiovascular

4. Neurological

5. Gastroenterological

6. Gynaecological

10

 Lymphangitis 1?

 Lymphadenopathy 2?

 Fever/chills

Management 3?

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

11

 

What do pts with COPD have?

1?

2?

3?

 

 

1. Asthma

2. Emphysema

3. Chronic bronitis

 

12

Atelectasis:

Collapse of the lung 

Clinical presentation: 

1?

2?

3?

4?

5?

 

1. +/- Elevated temp

2. Cough

3. Chest pain

4. Increased respiratory rate

5. Low O2 saturation

13

 

What are the treatment options for Atelectasis?

 

 

 

1. Deep breathing/spirometry

2. Fizziotherapy

3. Antibiotics

14

Atelectasis:

1? collapse

 Decreased perfusion ⇒  2?

 Usually apparent 3?

 Dx – x-ray – affected lobe is 4?

 

 

1.  Pulmonary

2. absorption alveolar gas ⇒collapse with accumulation of secretions and mucous

3.  post-op day 2

4. opaque

 

 

15

Pneumonia 

􀁢Post-op chest􀁠

Characteristics 1?

2? of all operations

 Predisposing factors 3?

Investigations 4?

Treatment 5?

 

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

 

16

 

What does the red arros show?

 

 

Unhealthy, white = congestion 

 

17

Pulmonary Embolism 

Blockage of 1? , usually originating as 2?

 Up to 10% 3?

 10% pts die 4?

 

 

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

 

18

 

What are the sign/symptoms of pulmonary embolism?

 

1.Sudden pleuritic pain

2. tachypnoea

3. haemoptysis,

4. fever, anxiety, wheeze, cough.

19

 

What are the treatment options for pulmonary embolism?

1?

2?

3?

 

 

 

1. Medical emergency

2. Fibrinolytic drugs

3. Embolectomy

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

 

 

 

1. 1. 25%

2. 0.25%

21

DVT 

Common after 1? operations

Possible outcomes:

2?

3?

4?

 

 

1. lower abdominal, pelvic and lower extremity

2. Fibrosis of clot with formation of collateral circulation

3. Pulmonary emboli

4. Post DVT syndrome

22

 

What is the Virchow's triad for DVT?

1?

2?

3?

 

 

1. Hypercoagulation 

2. Damage to vessel wall 

3. Venous stasis 

23

 

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

1?

2?

3?

4?

5?

6?

 

1. Immobility/bed rest

2. Increasing age

3. Minor surgery

4. Obesity

5. Varicose veins

6. Smoking

24

What are moderate risk factors for VTE?

1?

2?

3?

4?

5?

6?

7?

 

 

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

25

What are major risk factors for VTE?

1?

2?

3?

4?

 

1. Major fractures (especially hip)

2. Hip or knee joint replacement

3. Other major surgery/trauma

4. Spinal cord injury

26

What's the management option for DVT prophylaxis?

 Mechanical methods:

1?

 reduce risk of DVT by 2?

3?

Pharmacological methods: 4?

 

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)

27

Heparin use:

 For all high risk cases: 1?

 Consider for moderate & lower risk cases as

well

 

 

1. LMW heparin

 enoxaparin (Clexane) 20-40mg daily, or

 daltepain (Fragmin) 2,500-5,000 units daily, or

 Unfractionated heparin 5,000 units bd

28

1. The difference between Low molecular weight heparin and unfractioned Heparin?

2.  Advantage of LMWH?

3.  Advantage of UFH?​

 

 

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

29

 

What are the contraindications to anticoagulant prophylaxis?

1?

2?

3?

4?

5?

 

 

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

30

What's the contraindications to mechanical prophylaxis?

1?

2?

3?

4?

 

 

1. Severe peripheral arterial disease

2. Recent skin graft

3. Severe peripheral neuropathy

4. Severe leg deformity

31

Podiatric Surgical management:

 Aim to keep patient 1?

 Austin better than 2?

 Caution with 3?

 Compressive bandaging rather than 4?

 

1. ambulating

2.  CBWO

3.  extended use of K-wires

4. B-K casts

32

 

What is Pseudo-membranous enterocolitis

Uncommon fulminating bowel infection due to emergence of resistant strains of 1?

Sings and Symptoms 2?

Treatment 3?

 

 

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