CH 45 Perioperative, Intraoperative, & Postoperative Complications in Gynecologic Surgery

Question 1

DVT risk factors

Answer 1

serious and potentially preventable complication of major GYN surgery. Risk factors: malignancy, obesity, immobility, previous VTE, thrombophilia, smoking, estrogen containing hormone therapy use, and increasing age

Question 2

DVT clinical findings

Answer 2

patients present complaining of unilateral leg swelling and calf/leg pain, calf tenderness, warmth, or erythema, discrepancy in calf diameter. A cord can be palpated indicating a thrombosed vein, Homan’s sign (pain with dorsiflexion of the foot) may be positive but is not reliable

Question 3

DVT initial treatment

Answer 3

anticoagulants, even if not confirmed and suspicion high. Done with subq low molecular weight heparin without monitoring, IV Unfractionated heparin with monitoring, subq Unfractionated heparin with monitoring, weight based subq Unfractionated heparin without monitoring, and subq fondaparinux without monitoring.

Question 4

DVT treatment labs

Answer 4

INR and PTT measured at baseline and PTT should be at 1.5-2.5 times the control value for Unfractionated heparin

Question 5

Oral anticoagulants

Answer 5

started at same time as initial treatment at times since therapy is needed for 3-6 months. Oral meds not effective for 48-72 hours. Start coumadin at 5 mg daily and adjusted to keep INR in range of 2-3. treatment needed for 3-6 months.

Question 6

Surgical treatment for DVT

Answer 6

thrombectomy for patients with severe swelling. Also may place filter in inferior vena cava for those who have DVT or PE despite therapy or if anticoagulants are contraindicated

Question 7

Ileus

Answer 7

pattern of bowel dysmotility that results in accumulation of gas and fluid in GI tract. Can be caused by bowel manipulation during abdominal or pelvic surgery and opiates can prolong ileus

Question 8

Ileus clinical findings

Answer 8

abdomen pain, nausea, vomiting, abdominal distention, decreased or absent bowel sounds

Question 9

Ileus imaging findings

Answer 9

on xray, there is generalized dilatation and gaseous distention of both the small and large bowel

Question 10

Ileus treatment

Answer 10

NG tube if nausea, vomiting and abdominal distention are severe. IV fluids, electrolytes. Thoracic epidural analgesia use post-op has shown to promote quicker return to bowel function

Question 11

post op Urinary retention

Answer 11

inability to void in presence of full bladder within 8 hours after surgery or 8 hours after foley removed.

Question 12

Post op urinary retention risk factors

Answer 12

prolonged duration of surgery, use of regional anesthesia or epidural analgesia

Question 13

post op urinary retention signs ans symptoms

Answer 13

suprapubic discomfort, inability to void, palpable bladder

Question 14

Post op urinary retention imaging

Answer 14

diagnosis made when bladder US shows 500 ml of urine or if post void residual is over 500 ml

Question 15

Postop urinary retention complications

Answer 15

overdistended bladder can cause pain, and an autonomic response (vomiting, bradycardia, hypotension, and cardiac dysrhythmias). Infection related to urinary catheter. Ischemia and long term bladder dysfunction related to severe overdistention

Question 16

Postop urinary retention treatment

Answer 16

immediate bladder drainage with sterile cath. intermittent in and out caths are an alternative. may have cath placed for 24 hours then void trial. If incontinence procedure performed, patient may need cath for several days