Chapter 3: Post-Op Care Flashcards
Post Op Complications of Laparotomy
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)
Post Op Complications of Biliary Surgery
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
Post Op Complications of Thyroid Surgery
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
Post Op Complications of Mastectomy
Lymphoedema if Axillary Node sampling
Post Op Complications of Arterial Surgery
- 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
Post Op Complications of Colonic Surgery
- sepsis
- ileus
- fistulae
- anastomotic leak
- haemorrhage
- obstruction from adhesions
- trauma to ureters or spleen
Post Op Complications of Small Bowel Surgery
- Short gut syndrome (if small bowel is resected significantly)
- metabolic abnormalities (A, D, E, K, B12 deficiencies, Hyperoxaluria, bile salt depletion)
Post Op Complications of Tracheostomy
- Stenosis
- Mediastinitis
- Surgical emphysema
Post Op Complications of Splenectomy
- Acute gastric dilatation
- Thrombocytosis
- Sepsis
Post Op Complications of GU surgery
- Septicaemia
- Urinoma
Post Op Complications of Laparoscopic Cholecystectomy
5% - Conversion to open procedure
- 32% - CBD injury
- 2% - Bile Leak
- 1% - Post-op Haemorrhage
- 07% - Intra-abdominal abscess
What is a Loop Colostomy
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
What is an End Colostomy
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
What is a Double Barreled Colostomy
Brought out as a double-barrel + closed using as an enterotome
What is the incidence of Colostomies
1/50,000 per year
0.002%
What is an Ileostomy
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)
What is a defunctioning stoma
to relieve distal obstruction or protect distal anastomoses
do not reduce leakage rates + probably minimise the severity of leakage when it does occur
What is an alternative to Colostomies
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)
What is a urostomy
it brings urine from the ureters into the abdomen via an ileal conduit (usually incontinent)
Catheterisable valvular mechanism is made to retain continence
Name the different kinds of complications
Early Minor Early Major Late Minor Late Major General complications Specific complications Anaesthesia
Early Complications of a Stoma
haemorrhage at stoma site ischaemia - colour progress from grey to black High output: leads to K+ decrease Obstruction secondary to adhesions Stoma retractions
Delayed Complications of a Stoma
Obstruction Dermatititis around the stoma site stoma prolapse stomal intussusception stenosis parastomal hernia fistulae psychological problems
What should you avoid when choosing a stoma site
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
Where are colostomies placed?
on the left iliac fossa
