6: Surgery of the GI tract and its complications

Question 1

What are some cardiovascular complications of GI surgery?

Answer 1

Haemorrhage (massive loss of blood)

Myocardial infarction (MI)

Deep vein thrombosis (DVT)

Question 2

When may haemorrhage occur following a GI operation?

Answer 2

Immediately

In the 5-10 days following e.g due to infection

Question 3

What are the clinical signs of haemorrhage?

Answer 3

Blood

Tachycardia (heart attempting to compensate for reduced BP)

Hypotension (hypovolaemic shock)

Oliguria (kidneys retaining fluid to compensate for reduced BP)

Question 4

What is the emergency treatment for hypovolaemic shock due to haemorrhage?

Answer 4

Fluid resuscitation

Question 5

What is the presentation of MI following GI surgery?

Answer 5

Often silent

Cardiogenic shock due to heart failure

Arrythmia

Question 6

Putting aside risk factors for thromboembolism, why can a DVT occur during surgery?

Answer 6

Immobility

Hypercoagulable state of patient (loaded with drugs)

Question 7

What is the presentation of DVT?

Answer 7

Low grade fever

Ankle oedema

Calf/thigh pain

Calf swelling

Question 8

What can be seen in the ankles when a patient is suffering from fluid overload?

Answer 8

Pitting oedema

Question 9

Which test can be used to rule out DVT?

Answer 9

D-dimers (similar idea to PE, shows thrombosis)

Question 10

What is the clinical term for lung collapse?

Answer 10

Atelectasis

Question 11

What are some respiratory complications of surgery?

Answer 11

Atelectasis (lung collapse)

Pneumonia

Pulmonary embolism

Question 12

Lung collapse often progresses to ___.

Answer 12

infection

Question 13

Which cardiovascular condition commonly leads to pulmonary embolism?

Answer 13

DVT

Question 14

What is ileus?

Answer 14

Paralysis of the normal motility of the intestines

Question 15

What are some signs and symptoms of ileus following surgery?

Answer 15

Vomiting

Abdominal distension

Dehydration

Silent bowel sounds

Question 16

What is anastomotic dehiscence?

Answer 16

Iatrogenic disruption of anastomoses supplying the GI tract

Question 17

What are adhesions?

Answer 17

Fibrous connections:

bowel-bowel

bowel-abdominal wall

lung-chest wall

Question 18

Which molecule, associated with clotting, is involved in the formation of fibrous adhesions?

Answer 18

Fibrin

Question 19

What are some causes of bowel adhesions?

Answer 19

Inflammation

Ischaemia

Question 20

Adhesions are usually asymptomatic but can cause ___.

Answer 20

obstruction

Question 21

What are some urological complications of surgery?

Answer 21

Urine retention

UTI

Urethral stricture

Acute renal failure

Question 22

What are some neurological complications of surgery?

Answer 22

Confusion

Stroke

Damage to peripheral nerves