wk 8 6 Surgery and Complications

Question 1

3 likely carvdiovascular complications postop

Answer 1

haemorrhage
MI
DVT

Question 2

haemorrhage can be classified as reactionary or secondary, outline each

Answer 2

reactionary - immediately postop

secondary - infection (5-10d)

Question 3

how does a haemorrhage present 4

Answer 3

overt
tachycardia
hypotension
oliguria (low urine output)

Question 4

3 ways a haemorrhage can be prevented

Answer 4

perfect technique
sepsis advoidance
correction of coagulation disorders

Question 5

2 things which increase risk of MI

Answer 5

severe angina

previous MI

Question 6

how does MI postop present 3

Answer 6

often silent
cardiac failure / cardiogenic shock
arrhytmias

Question 7

2 things which help prevent MI postop

Answer 7

avoidance of perioperative hypotensioin

correction of ischaemic heart disease

Question 8

5 factors which increase DVT postop

Answer 8

age >40
previous DVT
majory surgery
Obesity
Malignancy

Question 9

immobility and ______ during surgery cause DVT

Answer 9

hypercoagulable state

Question 10

DVT postop presentation

Answer 10

Low grade fever (5-14d) 
unilateral ankle swelling 
Calf/thigh tenderness
Incr leg diameter
Shiny skin

Question 11

3 ways DVT should be investigated

Answer 11

D-dimer test
Doppler Ultrasound
Venography

Question 12

3 ways DVT can be prevented postop

Answer 12

compression stockings
Low-dose subcutaneous heparin
Early mobilisation

Question 13

3 respiratory complications postop

Answer 13

Atelectasis (complete/partial lung collapse)
Pneumonia
PE

Question 14

The collapse of lung tissue in atelectasis or pneumonia can be due to anesthesia, postop pain or aspiration, outline each

Answer 14

anesthesia - incr secretion and inhibits cilia
postop pain - inhibits coughing
aspiration - stomach contents

Question 15

5 ways a chest infection could present

Answer 15

low grade fever (0-2d) 
high grade fever (4-10d) 
Dyspnoea
Productive cough
Confusion

Question 16

3 ways chest infections could be prevented postop

Answer 16

stopping smoking
adequate analgesia
physiotherapy

Question 17

5 ways PE risk is increased postop

Answer 17

Age >40 
previous PE 
major surgery 
obesity
malignancy

Question 18

cause of PE

Answer 18

DVT

Question 19

presentation of postop PE 6

Answer 19

tachypnoea 
Dyspnoea
Confusion
Pleuritic pain 
Haemoptysis
Cardiopulmonary arrest

Question 20

investigations for postop PE

Answer 20

abnormal V/Q scan

CT pulmonary angiogram

Question 21

PE prevention 4

Answer 21

compression stockings (comes from DVT)
low-dose subcutaneous heparin
early mobilisation
Anticoagulation in presence of DVT

Question 22

3 GI postop problems

Answer 22

Ileus (peristalstic paralysis)
Anastomotic dehiscence (colorectal resection bursting at stitches)
Adhesions

Question 23

6 ways an ileus could occur postop

Answer 23

handling of bowel 
peritonitis
retroperitoneal injury
immobilisation 
hypokalaemia 
drugs

Question 24

ileus postop presentation 4

Answer 24

vomiting
ab distension
dehydration
silent abdomen

Question 25

3 ways an ileus can be prevented

Answer 25

minimal operative trauma laparoscopy avoidance of intra-abdominal sepsis

Question 26

anastomotic dehiscence is the breakdown of anastomosis, what 3 areas could this occur at

Answer 26

intestinal vascular urological

Question 27

3 causes of anastomotic dehiscence

Answer 27

poor technique poor blood supply tension of anastomosis

Question 28

outline how anastomotic dehiscence could be presented if intestinal, vascular or urological

Answer 28

intestinal - peritoneal - abscess - ileus - fistula vascular - bleeding/ haematoma urological - leakage of urine / urinoma

Question 29

3 ways anastomotic dehiscence could be prevented

Answer 29

good technique good blood supply no tension

Question 30

what is adhesions in operation

Answer 30

fibrin develops, leading to fibrous tissue

Question 31

outline 3 possible adhesions

Answer 31

bowel - bowel bowel - ab wall/other structures lung - chest wall

Question 32

2 ways adhesions occur

Answer 32

inflammatory response | ischaemia

Question 33

t/f adhesions to chest wall are asymptomatic

Answer 33

true

Question 34

4 key things to loook out for in intestinal obstructio n

Answer 34

vomiting pain distension constipation

Question 35

4 ways adhesions can be prevented

Answer 35

no powder on gloves avoidance of infection laparoscopic surgery sodium hyaluronidate (natural tissue lube)

Question 36

3 wound complications

Answer 36

infection dehiscence hernia

Question 37

wound infection can be either exogenous or endogenous, explain each

Answer 37

exogenous - trauma | endogenous - intestinal surgery

Question 38

presentation of wound infection 5

Answer 38

``` pyrexia (5-8d) redness pain swelling dischargw ```

Question 39

5 ways wound infections can be prevented

Answer 39

pre-op preparation skin cleansing aseptic technique avoidance of contamination prophylactic antibiotics

Question 40

4 complications in urinary

Answer 40

acute urinary retention UTI urethral stricture acute renal failure

Question 41

3 neurological complications postop

Answer 41

confusion stroke peripheral nerve lesions (ulnar/radial/sciatic/common peroneal nerves)

Question 42

how can confusion occur 7

Answer 42

``` hypoxia (Chest infection/PE/MI) oversedation sepsis electrolyte imbalance stroke hyper/hypoglycaemia alcohol/transquiliser withdrawal ```

Question 43

3 ways confusion can present

Answer 43

disorientation paranoia hallucinations

Question 44

4 ways confusion can be prevented

Answer 44

maintain oxygenation avoid dehydration avoid sepsis send home asap

Question 45

what should be avoided pre-op

Answer 45

no prolonged fasting selective bowel preparation no premedication

Question 46

what should be avoided peri-op

Answer 46

salt and water overload changes in body temp drains long acting anaesthetic agents

Question 47

postop should avoid

Answer 47

``` salt and water overload NG tube Catheters staying in for long delay in nutrition immobilisation ```