Surgery of the GI tract and its complication Flashcards Preview

Gastro > Surgery of the GI tract and its complication > Flashcards

Flashcards in Surgery of the GI tract and its complication Deck (55):
1

What might happen to a wound

Become infected
Not heal properly
Break down

2

What is the problem with laproscopic surgery

Can't see as much as open surgery
could create burns with instruments outwith view

3

What are the 3 main complications of Cardiovascular

Haemorrhage
MI
DVT

4

What are the 2 types of bleeding (haemorrhage)

Reactionary - immediately post op
Secondary - infection (5-10 days) uncommon

5

What are 4 presentations of haemorrhage

Overt
Tachycardia
Hypotension
Oliguria (low urine output)

6

How do we resussitate a patient with bleeding?

Fluids (increase BP and drop HR)

7

How can we prevent haemorrhage (3)

Meticulous technique
Avoidance of sepsis
Correction of coagulation disorders

8

What are the 2 main increased risk factors of MI

Severe angina
Previous MI

9

What is the mortality rate of MI with a bleed

50%

10

What is the presentation of a perioperative MI

Often silent
Cardiac faulure / cardiogenic shock
Arrythmias
May not have chest pain due to analgesia or anaesthetic

11

How can we prevent MI (3)

Delay surgery after MI by at least 6 months
Avoidance of perioperative hypotension
Correction of ischaemic heart disease (grafting and not stenting)

12

What is the benefit of grafting instead of stenting?

They don't need antiplatelet agents such as clopidogrel so they future surgery is easier

13

What are the increased risk factors of DVT

Age >40
Previous DVT
Major surgery
Obesity
Malignancy

14

What causes DVTs?

Immobility during surgery
Hypercoagulability

15

What are the 5 common presentations of DVT

Low grade fever (5-14 days)
Unilateral ankle swelling
Calf or thigh tenderness
Increased leg diameter
Shiny skin

16

What 3 things can we do to prevent DVT

Compression stockings
Low dose subcutaneous heparin
Early mobilisation

17

Why do we give Heparin before surgery sometimes?

Low doses of heparin is proven to prevent DVT

18

What are the 3 main respiratory complications

Atelectasis - collapse of the lung tissue
Pneumonia
Pulmonary embolism

19

What is atelectasiss

Collapse of lung tissue leading to infection

20

What are the risk factors of Atelectasis

Anaesthesia - increases secretion and inhibits cilia
Postoperative pain - inhibits coughing
Aspiration - stomach contents - damage from acid

21

How do chest infections commonly present?

Low grade fever (0-2 days)
High grade fever (4-10 days)
Dyspnoea
Productive cough
Confusion often due to hypoxia

22

How do we try to prevent chest infections

Stopping smoking (even just a few days
Adequate analgesia - allows them to take deep breaths more easily and allow them to cough
Physiotherapy

23

What are the commmon presentations of PE

Tachypnoea
Dyspnoea
Confusion
Pleuritic pain

24

How do we diagnose a PE

V/Q scan (ventilation perfusion scan)

25

What does a PE look like on a CT scanner

White - fluid

26

How can we prevent PE

Anticoagulation in presence of DVT
Early mobilisation
Lo-dose subcutaneous heparin
Compression stockings

27

What are the 3 major GI complications

Ileus
Anastomotic dehiscence
Adhesions

28

What is ileus

Paralysis of intestinal motility

29

What causes ileus

Handling the bowel
Peritonitis
Retroperitoneal injury - often RTA patients
Prolonged Immobilisation
Hypokalaemia
Drugs

30

What do ileus patients present with

Vomiting
Abdominal distension
Dehydration

31

How do we prevent ileus

Minimal operative trauma
Laparoscopy
Avoidance of intra-abdominal sepsis

32

What is an anastomotic breakdown

Not confined to the GI tract
Intestinal, vascular or urological

33

What causes anastomosis

Poor technique
Poor blood supply
Tension on anastomosis

34

What is the representation of vascular anastomosis

Bleeding /haematoma

35

What is the urological presentation of anastomosis

Leakage of urine / urinoma

36

What are the intestinal presentations of anastomosis

Peritonitis
Abscess
Ileus
Fistula

37

How can we prevent anasatomitic dehiscence

Good technique
good blood supply

38

What are adhesions particularly problematic for

Abdo surgery

39

What do adhesions stick together?

Bowel to bowel
Bowel to abdo wall
Lung to chest wall

40

What causes adhesions

Inflammatory response
Ischaemia

41

How do adhesions present?

Usually asymptomatic - to chest wall
Intestinal obstruction - vomiting, pain, distension, constipation

42

In what 4 ways can we prevent adhesions

No powder n gloves
Avoidance of infection
Laparoscopic surgery
Sodium hyaluronidate (chemical which can marginally reduce the risk- used on patient who gets recurrent adhesions)

43

What can happen to the wound

Infection
Breakdown
Hernia

44

What causes wound infection

Trauma - exogenous (RTA)
Intestinal surgery - endogenous

45

What are the presentations of wound infection

Pyrexia (5-8 days)
Redness
Pain
Swelling
Discharge

46

How can we prevent wound infection

Pre-op preparation
Skin cleansing
Aseptic technique
Avoidance of contamination
Prophylactic antibiotics

47

What is pre-op preparation and why is it under question

Laxatives to clear the bowel - watery stool is often more likely to cause infection

48

What are 4 complications of urinary surgery

Acute retention of urine
Urinary tract infection
Urethral stricture
Acute renal failure - with loss of blood if not properly resuscitated

49

Who is most likely to get a UTI?

Those with a urethral catheter

50

What are 3 complications of neurological surgery

Confusion
Stroke
Peripheral nerve lesions

51

What are the causes of confusion

HYPOXIA - chest infection, PE, MI
Oversedation
Sepsis
Electrolyte imbalance
Stroke
Hyper or hypoglycaemia
Alcohol or tranquilliser withdrawl

52

How does confusion present

Disorientation - time and place
Paranoia
Hallucinations - very common

53

How can we prevent confusion

Maintain oxygen
Avoid dehydration
Avoid sepsis
Send home ASAP

54

How can we minimise complications and their effect

Patients election and preparation
Careful surgery
Constant vigilance - early recognition of complications

55

What are the 3 objective of enhanced recovery after surgery

Pain control
GI function
Mobility

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