Complications of surgery Flashcards
Cardiovascular complications
Haemorrhage - reactionary, or secondary
M.I.
DVT
Reactionary haemorrhage
Immediate postoperative
Secondary haemorrhage
Infection (5-10 days)
Presentation of haemorrhage
Over
Tachycardia
Hypotensive
Oliguria
Prevention of haemorrhage
Meticulous technique
Avoidance of sepsis
Correction of coagulation disorders
MI presentation
Often silent (due to anaesthetics)
Cardiac failure/cardiogenic shock
Arrhythmias
MI Prevention
Delay surgery after an MI
Avoidance of preoperative hypotension
Correction of ischaemic HD first (stents)
DVT - risk, caused by
Increased risk - Age>40
Previous DVT
Majour surgery
Obesity
Malignancy
Caused by//
Immobility during surgery
Hypercoagulable state
DVT presentation
Low grade fever Unilateral ankle swelling Calf or thigh tenderness Increased leg diameter Shiny skin
DVT investigation
D dimer test - rule out test
Doppler ultrasound
Venography
DVT prevention
Compression stockings
Low does SC heparin
Early mobilisation
Respiratory
Atelectasis
Pneumonia
PE
Atelectasis
Collapse of lung tissue –> infection
Anaesthesia - increases secretion, inhibits cilia
Postoperative pain
- inhibits coughing
Aspiration
- stomach contents
Chest infection - presentation
Low/high grade fever
Dyspnoea
Productive cough
Confusion
What is confusion related to?
Hypoxia
Chest infection - prevention
Stop smoking
Adequate analgesia
Physiotherapy
Pulmonary embolism
DVT
Tachypnoea Dyspnoea Confusion Pleuritic pain Haemoptysis Cardiopulmonary arrest
Ileus (paralytic)
Causes
Paralysis of intestinal motility
Causes/
Handling of bowel
Peritonitis
Retroperitoneal injury
Immobilisation
Hypokalaemia
Drugs
Ileus - presentation
Vomiting
Abdo distension
Dehydration
Silent abdomen
Ileus - prevention
Minimal operative trauma
Laparoscopy
Avoidance of intra-abdo sepsis
Anastomotic dehiscence
Breakdown of anastomosis (connection of tissue surgically)
Caused by/
Poor technique
Poor blood supply
Tension on anastomosis
Anastomotic dehiscence - presentation
Intestinal
- peritonitis
- abscess
- ileus
- fistula
Vascular
- bleeding, haematoma
Urological
- leakage of urine/urinoma
Anastomotic dehiscence - prevention
Good technique
Good blood supply
No tension
Adhesions
- what is it
- caused by
Fibrin –> Fibrous tissue
- bowel to bowel
- bowel to abdominal wall
- lung to chest wall
Caused by
- inflammatory response
- ischaemia
Adhesions - presentation
Asymptomatic - to chest wall
Intestinal obstruction
- vomiting
- pain
- distension
- constipation
Adhesions - prevention
Avoidance of infection
laparoscopic surgery
Sodium hyaluronidate
Wound infection
Trauma
- exogenous
Intestinal surgery
- endogenous (bacteria in the intestine spills into peritoneal cavity/ wound)
Wound infection - presentation
Pyrexia Redness Pain Swelling Discharge
Wound infection - prevention
Pre-op prep
Skin cleansing
Aseptic technique
Avoidance of contamination
Prophylactic antibiotics - high risk ops
Urinary complications
Acute retention of urine
UTI - catheter
Urethral stricture - can occur after prolonged use of catheters
Neurological complicaitons
Confusion - hypoxia, PE, MI
Stroke
Peripheral nerve lesions
- ulnar nerve
- radial nerve
- sciatic nerve
- common perineal nerve
Confusion - causes
Hypoxia Chest infection PE MI Oversedation Sepsis Electrolyte imbalance Stroke Hyper or hyopglycaemia Alcohol or tranquilliser withdrawal
Confusion - presentation
Disorientation
- time
- place
Paranoia
Hallucinations
Confusion - prevention
Maintain oxygenation
Avoid dehydration
Avoid sepsis
Send home ASAP
Enhanced recovery after surgery (EHAS)
Enhanced care
Minimise post-op complications
Promotes - pain control, GI function, mobility
Pre op: Admission counselling, no prolonged fasting
Periop - short acting anaesthetic agents
- no drains
Post-op - early removal of catheter, early oral nutrition, no NG tubes
