Surgery Flashcards
(33 cards)
Complications of post op wound infection ?
- haemorrhage
- sepsis
- wound dehiscence
What antibiotics should be added to pre op prophylaxis in high risk MRSA patients ?
Teicoplanin or vancomycin
When should IV prophylactic antibiotics be administered before surgery ?
30 mins
What is the role of post op surgical drains ?
- vacuum to protect against collection, haematoma and seroma formation
- protect sites where leakage may occur e.g. Bowel anastomoses
- collect RBCs which can be auto transfused (protects against the risks of allotransfusion)
What is a seroma ?
- Pocket of clear serous fluid that sometimes develops in the body after surgery
- occurs when small blood vessels rupture and blood plasma seeps out
- inflammation caused by dying injured cells also contributes to the fluid
*in breast can cause necrosis of overlying tissue
What in particular should be checked for in Afro Caribbean patients before surgery if not already documented ?
Sickle cell trait
What is post operative ileus ?
Severe or absolute constipation and intolerance of oral intake (vomiting) due to non mechanical factors that disrupt the normal coordination of propulsive motor activity of GI tract
* certain degree is normal physiological response to surgery
How long after surgery should gut motility reappear ?
2-3 days
Presentation of post operative paralytic ileus
- vague, mild abdo pain and bloating
- nausea, vomiting, anorexia
- constipation
Difference between ileus and intestinal obstruction
- obstruction: pain more severe + cramping (not seen in ileus)
- obstruction = tinkling bowel sounds, ileus = absent
- obstipation more likely in obstruction
When does secondary post operative haemorrhage start ?
1-2 weeks post op
Warning sign of wound dehiscence
Serous pink discharge from wound
What general post op complications may present immediately ? (4)
- primary haemorrhage (starting during surgery or on Post opincreased BP - reactive bleeding)
- acetelectasis (minor lung collapse)
- shock: blood loss, acute MI, PE, septicaemia
- low urine output: inadequate fluid replacement intra or post operative lay
What is usually the cause of secondary post op bleeding ?
Infection
What complications may occur a within days post op ? (Early complications)
- acute confusion: dehydration, sepsis
- nausea and vomiting: analgesia/anaesthetic related or ileus
- fever
- secondary haemorrhage
- pneumonia
- wound dehiscence
- DVT
- acute urinary retention
- UTI
- infection
- bowel obstruction
Late complications of surgery
- bowel obstruction due to fibrous adhesions
- incisional hernia
- keloid formation
What complications are likely to present 3-5 days post op?
- sepsis, wound infection, abscess
- DVT
- bronchopneumonia
Factors affecting healing rate of surgical wounds ?
- poor blood supply
- excess suture tension
- long term steroids
- immunosuppressive therapy
- radiotherapy
- severe rheumatoid disease
- malnutrition
Risk factors for incision hernia ?
- obesity
- poor muscle tone
- wound infection
- multiple use of same incision site
Signs of post op acetelectasis
- usually mild and asymptomatic
- slow recovery from op, poor colour, mild tachypnoea, tachycardia
- may be associate with early post op fever
Signs of acute respiratory distress ?
- Rapid, shallow breathing, severe hypoxaemia with scattered crepitations
- usually 24-48 hrs after surgery
- no cough, chest pain or haemoptysis
When is sepsis, wound infection or abscess formation post surgery likely to present post op?
Day 3-5
What type of surgery do cellulitis and abscesses usually form after ?
Bowel-related surgery
How does acetelectasis occur post surgery ?
Alveolar collapse usually due to bronchial secretions obstructing airway
