Surgical Complications Flashcards
(38 cards)
What cardiovascular complications can occur after surgery?
Haemorrhage
Myocardial infarction (MI)
Deep vein thrombosis (DVT)
HOw soon after surgery can a haemorrhage occur?
- Immediate postoperative
OR Secondary
- e.g. due to Infection (5-10 days)
How do patients present with a post-operative haemorrhage?
- Tachycardia
- Hypotension
- Oliguria
HOw is a post-op haemorrhage prevented?
- Meticulous technique
- Avoidance of sepsis
- Correction of coagulation disorders
What increases a patient’s risk of post-op MI?
- Severe angina
- Previous MI
MIs post-op are often silent. So how do they present?
- Cardiac failure / cardiogenic shock
- Arrhythmias
HOw are post-op MIs prevented?
- Delay surgery after MI
- Avoidance of perioperative hypotension
- Correction of ischaemic heart disease
What factors increase the likelihood of a patient having a DVT after surgery?
- Age >40
- Previous DVT
- Major surgery
- Obesity
- Malignancy
Why does surgery cause patients to get a DVT?
- Immobility during surgery
- Hypercoagulable state
How do patient’s normally present with a DVT?
- Low grade fever (5-14 days)
- Unilateral ankle swelling
- Calf or thigh tenderness
- Increased leg diameter
- Shiny skin
What investigations can be used for DVT diagnosis?
- D-dimer test
(shows Degradation of fibrin) - Doppler Ultrasound
- Venography
How are further DVTs prevented?
- Compression stockings
- Low-dose subcutaneous heparin
- Early mobilisation
What respiratory complications can occur post-op?
- Atelectasis (collapsed lung usually after pneumonia)
- Pneumonia
- Pulmonary embolus (PE)
Why can surgery predispose a patient to pneumonia?
Anaesthesia
- Increases secretions and inhibits cilia
Postop. pain
- Inhibits coughing as this causes more pain for pt
Aspiration of stomach contents may occur
How can patients present with post-op pneumonia?
- Low grade fever (0-2 days)
- High grade fever (4-10 days)
- Dyspnoea
- Productive cough
- Confusion
How can post-op pneumonia be prevented as much as possible?
- Stopping smoking
- Adequate analgesia
- Physiotherapy
What increases the risk of a patient having a PE after surgery?
Age > 40 Previous PE Major surgery Obesity Malignancy
How do patients normally present with a PE?
- Tachypnoea
- Dyspnoea
- Confusion
- Pleuritic pain
- Haemoptysis
- Cardiopulmonary arrest
What investigations can be used to diagnose a PE?
V/Q scan
CT pulmonary angiogram
HOw can we aim to prevent post-op PEs?
- Compression stockings
- Low-dose subcutaneous heparin
- Early mobilisation
- Anticoagulation in presence of DVT
What GI complications can occur post operatively?
- Ileus
- Anastomotic dehiscence
- Adhesions
What is an ileus and what part of an operation can cause this?
Paralysis of intestinal motility
Caused by:
- Handling of bowel
- Peritonitis
- Retroperitoneal injury
- Immobilisation
- Hypokalaemia
- Drugs
How do patients present with an ileus?
- Vomiting
- Abdominal distension
- Dehydration
- Silent abdomen
How can we aim to prevent an ileus occurring post-operatively?
- Minimal operative trauma
- Laparoscopy
- Avoidance of intra-abdominal sepsis
