Surgery Flashcards
(57 cards)
When do most post-op complications occur?
1-3 days after
Atelectasis
Partial or complete lung collapse. Lack of gas exchange in alveoli, due to alveolar collapse or fluid consolidation.
Basal atelectasis
The collapse of basally oriented lung tissue, a common post-operative complication, which is associated with mucus retention due to poor pulmonary clearance, and secondary infection.
Clinical findings
Dyspnoea, tachycardia, pyrexia, cyanosis, pain on coughing, reduced expectoration, secondary bacterial infection, reduced chest movement especially on affected side, basal dullness, crepitation on breathing.
Imaging
Opacity of involved segment, mediastinal shift to affected side.
Risk factors
Abdominal distension, emphysema, intubation, irritation from anaesthetics, mechanical trauma to airways, muscle weakness, obesity, opiate use for pain, post-operative drowsiness, pregnancy, smoking, wound pain.
Complications that tend to happen immediately following surgery
Primary haemorrhage
Basal atelectasis
Shock
Low urine output
Complications that tend to occur early after surgery
Acute confusion Nausea, vomiting Fever 2° haemorrhage Pneumonia Dihescence DVT Acute urinary retention UTI Infection Bowel obstruction Paralytic ileus
Paralytic ileus
Paralytic ileus is the occurrence of intestinal blockage in the absence of an actual physical obstruction. This type of blockage is caused by a malfunction in the nerves and muscles in the intestine that impairs digestive movement
Dihiscence
Rupture along anatomical line, fault
Wound dihescense
Two sides of incision come apart
2% of midline laparotomy wounds, usually 7-10 days post-op
Serious – up to 30% mortality
Anastomosis dihescence
Anastomoses are created by surgically attaching to previously unattached lumen-containing structures (ie intestines)
Dihescence is the separating of those structures.
Serious complication following intestinal surgery.
Post-surgical complications that occur late after the procedure
Bowel obstruction
Incisional hernia
Persistent sinus
Recurrence of original problem
Consumptive coagulopathy
Hemorrhagic disorder that occurs following the uncontrolled activation of clotting factors and fibrinolytic enzymes –> tissue necrosis and bleeding.
May result post op from large volume blood transfusion, anticoagulant meds, pre-existing/undiagnosed condition
Main cause of post-op morbidity following intestinal surgery
Infection.
Superficial often staph.
Keyhole vs laparoscopic sugary
Keyhole: small incision, use of fibre optic lights sources and little itty bitty instruments.
Laparoscopic: keyhole specifically inside the abdomen and peritoneal cavity.
Most common complication following abdominal surgery
Infection (especially staph)
Post-operative cellulitis/abscesses
Usually present within 1 week, but can manifest up to three weeks after.
Fever, spreading
Cellulitis: antibiotics
Abscesses: opened and cleaned and left to heal by 2nd intention
Gas Gangrene
Uncommon; potentially fatal
Bacterial gas-producing infection.
C perfringens
Spreads quickly.
Wound sinus
Late post-op complication from deep chronic abscess.
A wound sinus is a discharging blind-ended track that extends from the surface of an organ to an underlying area or abscess cavity
Usually caused by infection, liquefaction, or foreign body.
Factors which may affect wound healing
Poor blood supply Excess suture tension Long term steroid use Immunosuppressive therapy Radiotherapy Severe rheumatoid disease Malnutrition
Incisional hernia
Incompletely healed surgical wound through which intestines (or other viscera) protrude.
10-15% abdominal wounds. Usually within first year, but up to 15 years possible.
How many major surgeries/general anaesthetics result in respiratory complications?
15%
Aspiration pneumonitis
Sterile inflammation of
lungs from inhaling gastric contents
50% mortality
History of vomiting/regurgitation, or emergency surgery with full stomach.
Acute Respiratory Distress Syndrome
Surfactant dysfunction with resultant inflammation.
Results from direct or systemic insult to lung.
24-48 hours post-op
ICU – mechanical ventilation with positive-end pressure
Thrombo-embolism
Major cause of complications and mortality post-op
Obstruction of a blood vessel by a blood clot that has become dislodged from another site in the circulation.
Pulmonary embolism
Presents with sudden dyspnea, cardiovascular collapse, pleuritic chest pain, hemoptysis
Smaller PEs can present with confusion, breathlessness, chest pain.
Most frequently arise from DVTs
