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PodMed > Post-operation complications (Surgery) > Flashcards

Post-operation complications (Surgery) Flashcards

1
Q

What are some of the local complications post surgery?

1?

2?

3?

4?

5?

6?

7?

8?

A

1. Haemorrhage

2. Wound dehiscence

  1.  Wound infection
  2.  Scar formation
  3.  Neuropraxia
  4.  Delayed/non/mal-union

7. Return of original deformity

8. Iatrogenic deformity

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2
Q

What factors could result in Haemorrhage?

 Poor 1?

 Poor 2?

 Ambulate patient 3?

4? therapy/thrombocytopaenia

 Result

5?

6?

7?

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

 Result

  1. Wound dehiscence
  2. Infection
  3. Scaring
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3
Q

Keloid scars

1? tumors

 Composed mainly of an 2?

 More common in 3?

Tx – 4?

A
  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
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4
Q

Hypertrophic scar formation

definition 1?

Poor 2?

• Excessive use of 3?

Wound dehiscence

Infection

•Poor scar management

post-suture removal

A
  1. Raised scars that do not grow beyond the boundaries of the original wound
  2. suturing technique
  3. electrocautery
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5
Q

What are some signs of infection post-operatively?

 Abnormal 1?

2?

 Wound 3?

4?

A
  1. post-op pain after 2-5 days
  2.  Dolor, oedema & erythema
  3. dehiscence/discharge
  4. Cellulitis - local extension of inflammation
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6
Q

How do you manage local infection?

 Drainage of 1?

removal of 2?

 Irrigation and wound dressing

 MCS +/- FBC

A
  1. wound
  2. some or all sutures
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7
Q

What are the choices of antibiotics for local infections?

1?

(delayed allergy to penicillin) 2?

(immediate allergy to penicillin) 3?

A
  1. Oral di/flucloxacillin 500 mg qid
  2. Oral cephalexin 500 mg qid
  3. Oral clindamycin 450mg tid
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8
Q

What are some complications following matrixecotomies?

1?

2?

3?

A
  1.  Hypergranulation tissue
  2.  Infection
  3.  Phenol􀁢burn
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9
Q

What are the general complications post surgery?

A
  1.  Extension of local infection
  2.  Pulmonary

3. Cardiovascular

4. Neurological

5. Gastroenterological

6. Gynaecological

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10
Q

 Lymphangitis 1?

 Lymphadenopathy 2?

 Fever/chills

Management 3?

A
  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
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11
Q

What do pts with COPD have?

1?

2?

3?

A
  1. Asthma
  2. Emphysema
  3. Chronic bronitis
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12
Q

Atelectasis:

Collapse of the lung

Clinical presentation:

1?

2?

3?

4?

5?

A
  1. +/- Elevated temp
  2. Cough
  3. Chest pain
  4. Increased respiratory rate
  5. Low O2 saturation
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13
Q

What are the treatment options for Atelectasis?

A
  1. Deep breathing/spirometry
  2. Fizziotherapy
  3. Antibiotics
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14
Q

Atelectasis:

1? collapse

 Decreased perfusion ⇒ 2?

 Usually apparent 3?

 Dx – x-ray – affected lobe is 4?

A
  1. Pulmonary
  2. absorption alveolar gas ⇒collapse with accumulation of secretions and mucous
  3. post-op day 2
  4. opaque
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15
Q

Pneumonia

􀁢Post-op chest􀁠

Characteristics 1?

2? of all operations

Predisposing factors 3?

Investigations 4?

Treatment 5?

A
  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
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16
Q

What does the red arros show?

A

Unhealthy, white = congestion

17
Q

Pulmonary Embolism

Blockage of 1? , usually originating as 2?

 Up to 10% 3?

 10% pts die 4?

A
  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
Q

What are the sign/symptoms of pulmonary embolism?

A
  1. Sudden pleuritic pain
  2. tachypnoea
  3. haemoptysis,
  4. fever, anxiety, wheeze, cough.
19
Q

What are the treatment options for pulmonary embolism?

1?

2?

3?

A
  1. Medical emergency
  2. Fibrinolytic drugs
  3. Embolectomy
20
Q

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

A
    1. 25%
  2. 0.25%
21
Q

DVT

Common after 1? operations

Possible outcomes:

2?

3?

4?

A
  1. lower abdominal, pelvic and lower extremity
  2. Fibrosis of clot with formation of collateral circulation
  3. Pulmonary emboli
  4. Post DVT syndrome
22
Q

What is the Virchow’s triad for DVT?

1?

2?

3?

A
  1. Hypercoagulation
  2. Damage to vessel wall
  3. Venous stasis
23
Q

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

1?

2?

3?

4?

5?

6?

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

4. Obesity

5. Varicose veins

6. Smoking

24
Q

What are moderate risk factors for VTE?

1?

2?

3?

4?

5?

6?

7?

A

1. Malignancy

2. Heart or respiratory failure

  1.  Oestrogens (HRT or OCP)
  2.  Previous DVT/PE

5. Most non-major surgery

6. Thrombophilia

7. Postpartum period

25
Q

What are major risk factors for VTE?

1?

2?

3?

4?

A
  1.  Major fractures (especially hip)
  2.  Hip or knee joint replacement

3. Other major surgery/trauma

4. Spinal cord injury

26
Q

What’s the management option for DVT prophylaxis?

 Mechanical methods:

1?

 reduce risk of DVT by 2?

3?

Pharmacological methods: 4?

A
  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
Q

Heparin use:

 For all high risk cases: 1?

 Consider for moderate & lower risk cases as

well

A
  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
Q
  1. The difference between Low molecular weight heparin and unfractioned Heparin?
  2. Advantage of LMWH?

3.  Advantage of UFH?​

A
  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
Q

What are the contraindications to anticoagulant prophylaxis?

1?

2?

3?

4?

5?

A
  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
Q

What’s the contraindications to mechanical prophylaxis?

1?

2?

3?

4?

A
  1. Severe peripheral arterial disease
  2. Recent skin graft
  3. Severe peripheral neuropathy
  4. Severe leg deformity
31
Q

Podiatric Surgical management:

 Aim to keep patient 1?

 Austin better than 2?

 Caution with 3?

 Compressive bandaging rather than 4?

A
  1. ambulating
  2. CBWO
  3. extended use of K-wires
  4. B-K casts
32
Q

What is Pseudo-membranous enterocolitis?

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

Sings and Symptoms 2?

Treatment 3?

A
  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

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