Postoperative complications

Question 1

what are the main cardiovascular postoperative complications?

Answer 1

haemorrhage, MI and DVT

Question 2

what are the two types of haemorrhage

Answer 2

reactionary (immediate postoperative, this is more common )

secondary (due toinfection)

Question 3

symptoms of haemorrhage?

Answer 3

Tachycardia, hypotension and oliguria

Question 4

need to be aware of ____ ____ in haemorrhage e.g. jaundiced patients

Answer 4

coagulation disorders

Question 5

what are the risk factors of having an MI postoperatively ?

Answer 5

severe angina, previous MI

Question 6

how does MI present postoperatively

Answer 6

the actual event is often silent so often present with cardiac failure/ cardiogenic shock or arrhythmias

Question 7

how is postoperative MI prevented? 3

Answer 7

dont do the surgery !

avoid hypotension

correct the IHD first! - but usually through cabg because stenting requires antiplatelets which could increase risk of haemorrhage

Question 8

how does postoperative DVT present?

Answer 8

Low grade fever (5-14 days)

Unilateral ankle swelling
Pitting oedema

Calf or thigh tenderness

Increased leg diameter

Shiny skin - because stretched

Question 9

how is DVT investigated?

Answer 9

D-dimer (if normal can rule out DVT)

doppler ultrasound

venography

Question 10

how is DVT prevented?

Answer 10

compression stockings

low dose subcutaneous heparin

early mobilisation

Question 11

how do compression stockings work?

Answer 11

Compress the external veins so encourages blood flow to the deep veins of the leg and reduces risk of DVT

Question 12

what are the main respiratory postoperative complications?

Answer 12

atelactasis/ aspiration

chest infection

PE

Question 13

why may people aspirate ? 3

Answer 13

anaesthesia causes increased secretion, inhibits cilia and so you get mucus plugs which are not able to clear properly

post operative pain - prevents cough

vomiting after surgery

Question 14

what is the presentation of chest infection?

Answer 14

Low grade fever (0-2 days) - almost always due to mild chest infection

High grade fever (4-10 days)

Dyspnoea

Productive cough

Confusion - because of hypoxia

Question 15

how is chest infection prevented in people with pre-existing lung disease

Answer 15

physiotherapy

Question 16

how is PE investigated?

Answer 16

D-dimer

multiple-detector computed tomographic pulmonary angiography (CTPA) of chest

ventilation-perfusion scan (V/Q scan) - not as common now

Question 17

how is PE prevented?

Answer 17

Compression stockings

Low-dose subcutaneous heparin

Early mobilisation

Anticoagulation in presence of DVT - start with heparin and move onto warfarin

Question 18

what are the main GI postoperative complications?

Answer 18

ileus, anastomotic dihiscence and adhesions

Question 19

what is ileus? and what are the causes?

Answer 19

This is paralysis of intestinal motility

Handling of bowel
Peritonitis
Retroperitoneal injury
Immobilisation
Hypokalaemia
Drugs

Question 20

how does ileus present?

Answer 20

Vomiting
Abdominal distension
Dehydration
Silent abdomen

Question 21

how is ileus prevented?

Answer 21

Minimal operative trauma
Laparoscopy
Avoidance of intra-abdominal sepsis

Question 22

what is anastomotic dihiscence? and what are the types ?

Answer 22

Breakdown of anastomosis

Intestinal
Vascular - would get bleeding
Urological

Question 23

what are the symptoms of intestinal anastomotic dihiscence?

Answer 23

Peritonitis - quite rare
Abscess
Ileus - almost certainly get this
Fistula

Question 24

what are the symptoms of vascular anastomotic dihiscence?

Answer 24

bleeding/haematoma

Question 25

what are the symptoms of urological anastomotic dihiscence?

Answer 25

Leakage of urine / urinoma

Question 26

why do you get adhesions/

Answer 26

caused by a combination of inflammatory repsonse and ischaemia

Question 27

Anyone who has had a major abdominal operation will get adhesions and bowel can get stuck - this is probably one of the commonest causes of ____- _____

Answer 27

Anyone who has had a major abdominal operation will get adhesions and bowel can get stuck - this is probably one of the commonest causes of intestinal obstruction

Question 28

when would an adhesion be assymptomatic?

Answer 28

adhesion to chest wall

Question 29

what are the other presentations of adhesions?

Answer 29

intestinal obstrction - symptoms are vomiting, pain, distension, constipation

Question 30

what may be given to a patients who is at risk of adhesions to prevent them forming? note: this will be certainly given to patients who are undergoing surgery to treat the adhesions

Answer 30

sodium hyaluronidate

Question 31

what are the main wound postoperative complications?

Answer 31

infection, dihiscence and hernia

Question 32

what do people with wound infection present like?

Answer 32

``` Pyrexia (5-8 days) Redness Pain Swelling Discharge ```

Question 33

what are the main urinary postoperative complications?

Answer 33

UTI - because of catheter urethral stricture - associated with prolonged catheter acute renal failure - prolonged blood loss

Question 34

what are the main neurological postoperative complications?

Answer 34

confusion, stroke, peripheral nerve lesions