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Gen Surg > Chapter 3: Post-Op Care > Flashcards

Chapter 3: Post-Op Care Flashcards

1
Q

Post Op Complications of Laparotomy

A

if elderly or malnourished
wound may break down from a few days to a few weeks post op: infection/haematoma
serious wound dehiscence = burst abdomen (which eviscerates the bowel)

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2
Q

Post Op Complications of Biliary Surgery

A

T-tube is usally left in the bile duct to allow drainage of stones
Cholangiogram done within 8-10 days to see if drainage is complete.
Retained stones require ERCP/surgery/ additional agents to remove them because
- Fistula formation
- CBD stricture
- Cholangitis
- Bleeding into the biliary tree
- Jaundice
- Haematemesis
- Pancreatitis
- Biliary peritonitis

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3
Q

Post Op Complications of Thyroid Surgery

A

Recurrent laryngeal nerve palsy (hoarseness) - permanent or transient
altered voice + oedema due to intubation being inserted in the oesophagus
Due to haematom of the wound:
- Hypothyroidism
- Hyperthyroidism
- Thyroid storm
- Tracheal obstruction

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4
Q

Post Op Complications of Mastectomy

A

Lymphoedema if Axillary Node sampling

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5
Q

Post Op Complications of Arterial Surgery

A
  • Bleeding
  • Ischaemia
  • Thrombosis
  • Embolism
  • Graft infection
  • MI
  • AV fistula formation
  • renal failure
  • respiratory distress
  • aorto-enteric fistula
  • trauma to ureters
  • trauma to anterior spinal artery
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6
Q

Post Op Complications of Colonic Surgery

A
  • sepsis
  • ileus
  • fistulae
  • anastomotic leak
  • haemorrhage
  • obstruction from adhesions
  • trauma to ureters or spleen
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7
Q

Post Op Complications of Small Bowel Surgery

A
  • Short gut syndrome (if small bowel is resected significantly)
  • metabolic abnormalities (A, D, E, K, B12 deficiencies, Hyperoxaluria, bile salt depletion)
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8
Q

Post Op Complications of Tracheostomy

A
  • Stenosis
  • Mediastinitis
  • Surgical emphysema
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9
Q

Post Op Complications of Splenectomy

A
  • Acute gastric dilatation
  • Thrombocytosis
  • Sepsis
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10
Q

Post Op Complications of GU surgery

A
  • Septicaemia

- Urinoma

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11
Q

Post Op Complications of Laparoscopic Cholecystectomy

A

5% - Conversion to open procedure

  1. 32% - CBD injury
  2. 2% - Bile Leak
  3. 1% - Post-op Haemorrhage
  4. 07% - Intra-abdominal abscess
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12
Q

What is a Loop Colostomy

A

When a loop of colon is externalised and partially sectioned to allow faeces to slip out. The loop is held by a rod between it and the skin, to prevent it from being suctioned back in. This is removed 7days after the op.
v prone to complications

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13
Q

What is an End Colostomy

A

The Bowel is divided into 2:
the proximal is brought out to be a stoma
the distal end is either
- Resected
- Closed
- Exteriorised: and made a mucous fistula

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14
Q

What is a Double Barreled Colostomy

A

Brought out as a double-barrel + closed using as an enterotome

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15
Q

What is the incidence of Colostomies

A

1/50,000 per year

0.002%

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16
Q

What is an Ileostomy

A

a protrusion from the skin which leaks several active enzymes. these can digest the skin, which means the skin needs protecting.
End ileostomy follows proctocolectomy (from UC)

17
Q

What is a defunctioning stoma

A

to relieve distal obstruction or protect distal anastomoses

do not reduce leakage rates + probably minimise the severity of leakage when it does occur

18
Q

What is an alternative to Colostomies

A

Total Anorectal reconstruction
the gracilis is disconnected distally and attached to the rectum. It is then activated using a impulse generator implant in the abdomen to trigger bowel action (via hand-held radiofrequency controller)

19
Q

What is a urostomy

A

it brings urine from the ureters into the abdomen via an ileal conduit (usually incontinent)
Catheterisable valvular mechanism is made to retain continence

20
Q

Name the different kinds of complications

A 
Early Minor
Early Major
Late Minor
Late Major
General complications
Specific complications
Anaesthesia
21
Q

Early Complications of a Stoma

A 
haemorrhage at stoma site
ischaemia - colour progress from grey to black
High output: leads to K+ decrease
Obstruction secondary to adhesions
Stoma retractions
22
Q

Delayed Complications of a Stoma

A 
Obstruction
Dermatititis around the stoma site
stoma prolapse
stomal intussusception
stenosis
parastomal hernia
fistulae
psychological problems
23
Q

What should you avoid when choosing a stoma site

A 
Bone prominences
umbilicus
old wounds/scars (due to presenting adhesions)
skin folds and creases
waistline

Note: site should be assessed pre-op by the stoma nurse. pt has to be sitting down and standing up

24
Q

Where are colostomies placed?

A

on the left iliac fossa

25
Q

Where are ileostomies placed?

A

on the right iliac fossa

26
Q

On the left iliac fossa, which kind of stoma is placed?

A

Colostomy

27
Q

On the right iliac fossa, which kind of stoma is placed?

A

Ileostomy

28
Q

What are the 8 causes of malnutrition

A
  • missing meals
  • enforced starvation
  • difficulty with feeding
  • unappetising food
  • increased nutritional requirements (sepsis, burns)
  • increased nutritioal losses (malabsoprtion)
  • decreased intake (dysphagia, sedation, coma)
  • effect of treatment (N + V + D)
29
Q

How do you identify a malnourished pt?

A

History: change in diet, pain, n+v+d, wt loss
Examination: dehydration (can be mistaken as malnoutrition too, since they are hand in hand), overhydration can mask malnoutrition; assess weight and height
Invstigations: nil, perhaps albumin can be suggestive of it - an increased albumin can recover.

30
Q

How do you prevent malnutrition:

A

Identify nutrition state and weight
Identify risk fractures
Identify uninterrupted meals

31
Q

How do you identify whether pt needs ng tube or semi solids?

A

Pt must not choke on semi solids or be at risk of aspiration. if s/he is: insert a fine bore ng tube.

32
Q

Name two types of enteral nutrition

A

Polymeric: undigested foods containing protein, carbs, long chained fats and starches
Elemental: singular proteins, amino acids, oligo- and mono- saccharides done

33
Q

How would you manage an ng tube

A
  • make sure its of fine bore
  • check position of ng tube before u start feeding
  • build up feeds gradually to avoid diarrhoea and distension
  • weigh pt weekly and check blood glucose + plasma electrolytes
  • treat underlying conditions
34
Q

What is Parenteral Nutrition

A

It is a fluid filled with nutrients being pumped into the patient through a central venous line (lasts longer than if given through a peripheral line).
Note: peripheral line is tricky to insert
2000kCal and 10-14g of N2 in 2/3L of fluid
50% calories via fat, 50% calories via carbs
Vitamins, minerals, trace elements, electrolytes

35
Q

Complications of Parenteral Nutrition

A

Sepsis: pyrexia spike, take cultures, check wound, remove central line
Thrombosis (PE, vena caval obstruction), heparin is given with the nutrient solution
Metabolic imbalance: electrolyte abnormalities, plasma glucose is deranged, hyperlipidaemia, deficiency syndromes, acid-base disturbances
Mechanical: pneumothorax

36
Q

Guidelines of Parenteral Nutrition

A

Keep sterile
Remove line if infection suspected
Review fluid balance 2wice daily
check urine glucose, fluid balance, weight
check for electrolytes, CBC until stable, then 3x week
check LFT and lipid clearance 3x a week until stable = weekly
treat underlying conditions

37
Q

What is refeeding syndrome

A

it is a life-threatening metabolic complication of feeding a pt after a long period of starvation (via any route)
when initiating feeding, the low amount of insulin found in the body will spike up. this will allow the catabolic state to deplete the intracellular stores of phosphate (serum content remains normal).
A hypophosphataemic state develops, allowing for rhabdomyolysis, red+white cell dysfunction, resp insufficiency, arrhythmias, cardiogenic shock, shock seizures and sudden death.

Gen Surg (6 decks)

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