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Peri-Operative Care [16] > Anastomotic Leak > Flashcards

Anastomotic Leak Flashcards

1
Q

What are anastomotic leaks defined as?

A

A leak of luminal contents from a surgical join

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2
Q

How important are of anastomotic leaks?

A

They are the most important complication to recognise following GI surgery

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3
Q

What is key with anastomotic leaks?

A

Early diagnosis, resuscitation, and treatment

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4
Q

What does delay in recognition and management of anastomotic leaks lead to?

A

Prolonged contamination of the abdomen or chest by luminal contents, leading to development of severe sepsis and progression to multi-organ failure and death

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5
Q

Who should be considered to have an anastomotic leak until proven otherwise?

A

Any patient who is not progressing as expected or deteriorates after surgery

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6
Q

What are the risk factors for anastomotic leak divided into?

A
  • Patient factors

- Surgical factors

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7
Q

What are the patient risk factors for anastomotic leak?

A
  • Medication
  • Smoking or alcohol excess
  • Diabetes
  • Obesity or malnutrition
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8
Q

What medication can increase the risk of anastomotic leak?

A
  • Corticosteroids

- Immunosuppressants

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9
Q

What surgical factors can increase the risk of anastomotic leak?

A
  • Emergency surgery
  • Longer intra-operative time
  • Peritoneal contamination
  • Oesophageal-gastric or rectal anastomosis
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10
Q

What are the most common clinical features of anastomotic leak?

A
  • Abdominal pain

- Fever

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11
Q

When do the symptoms of anastomotic leak present?

A

5-7 days post-op

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12
Q

What are the other clinical features of anastomotic leak?

A
  • Delirium

- Prolonged ileus

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13
Q

What may be found on examination in anastomotic leak?

A
  • Pyrexia
  • Tachycardia
  • Peritonism
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14
Q

What is it important to check for in examination for suspected anastomotic leak?

A

Faeculent/purulent material or bile in any drains

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15
Q

What is the definitive investigation for a suspected anastomotic leak?

A

CT with contrast or abdomen and pelvis (or CAP for an intra-thoracic anastomosis)

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16
Q

Why is CT with contrast the investigation of choice for suspected anastomotic leak?

A

Will demonstrate the presence of any extraluminal contents

17
Q

What is important to ensure in any suspected case of anastomotic leak?

A

Early resuscitation and senior input

18
Q

What other initial investigations should be done in suspected anastomotic leak?

A
  • Urgent blood tests
  • VBG
  • G&S
19
Q

What urgent bloods should be done in suspected anastomotic leak?

A
  • FBC
  • CRP
  • LFTs
  • Clotting screen
20
Q

Why should a VBG be done in suspected anastomotic leak?

A

Assess degree of tissue perfusion

21
Q

Why should a G&S be done in suspected anastomotic leak?

A

Needed for possible surgery or radiological drainage

22
Q

What do the key immediate principles of anastomotic leak relate to?

A

Treatment of potential contamination and resultant sepsis

23
Q

What does any suspected anastomotic leak require in terms of review?

A

Urgent senior review

24
Q

What is involved in the initial management of anastomotic leak?

A
  • Ensure patient is NBM
  • Start broad spectrum antibiotic cover
  • Start IV fluid therapy
  • Insert urinary catheter (to enable monitoring of fluid balance)
25
Q

What does the definitive management of anastomotic leak depend on?

A
  • Extent of leak
  • Extent of contamination
  • Physiological status of patient
26
Q

How can minor anastomotic leaks be managed?

A

Conservatively

27
Q

What is involved in the conservative management of anastomotic leaks?

A

IV antibiotics

28
Q

When can anastomotic leaks be managed with IV antibiotics?

A

Collections <5cm

29
Q

What may be required for larger anastomotic leaks?

A

Percutaneous drainage

30
Q

What may be required for anastomotic leaks if the patient is septic or has multiple collections?

A

Exploratory lapatotomy

31
Q

What does an exploratory laparotomy for anastomotic leaks usually involve?

A

Extensive wash outs with large drain insertion

32
Q

What is usually required in the case of a colorectal anastomotic leak if septic/multiple collections?

A

Stoma insertion

33
Q

What is it important to pay close attention to, if the leak is managed surgically or conservatively?

A

Patient’s nutrition

34
Q

What may be required nutritionally for patients with anastomotic leaks?

A

Act pre-emptively, including considering parenteral nutrition if the patient is likely to be NBM for an extended period of time

Peri-Operative Care [16] (20 decks)

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