Complications of surgery Flashcards
what are the cardio complications
haemorrhage, MI, DVT
what are the types of haemorrhage complications
reactionary (immediate postoperative)
secondary (infection 5-6 days)
how does a haemorrhage present
obvious
- tachycardia
- hypotension
- oliguria
how can haemorrhage be avoided
meticulous technique, avoidance of sepsis, correction of coagulation disorders
what is the mortality of post op MI
50%
how do post op MIs usually present
often silent,
cardiac failure/ cardiogenic shock,
arrythmias
how is MI avoided
delay of surgery after MI,
avoidance of perioperative hypotension,
correction of ischaemic heart disease
what cause a DVT in surgery
immobility, hypercoagulable states
does malignancy increase your risk of DVT
yes
how does DVT present
low grade fever, unilateral ankle swelling, calf or thigh tenderness, increased leg diameter, shiny leg
how are DVT investigated
D dimer test, doppler ultrasound, venography
how are DVTs prevented
compression stockings, lose dose subcutaneous heparin, early mobilisation
what are the resp complications
atelectasis (partial or complete collaspe of the lung due to deflation of the alveoli)
pneumonia
pulmonary embolus
how are atelectasis and pneumonia linked
collapse of lung tissue can lead to infection
what causes infection post op
anaesthesia- increases secretion, inhibits cilia
post op pain- inhibits coughing
aspiration- stomach contents
how does a chest infection present
low grade fever (0-2 days), high grade fever (4-10),
dyspnoea
productive cough
confusion
how do you prevent chest infestions
stopping smoking,
adequate analgesia,
physiotherapy
what causes a post op PE
DVT
what is the presentation of a PE
tachypnoea, dyspnoea,
confusion,
pleuritic pain, haemoptysis, cardiopulmonary arrest
what are the two methods of V/Q scan
injection of albumin tagged with radionuclide
inhalation of gaseous radionuclide
how is a PE prevented
compression stockings, low dose subcutaneous heparin,
early mobilisation,
anticoagulation in presence of DVT
what are the GI complications
ileus,
anastomotic dehiscence (in colorectal resections),
adhesions
what is an ileus
paralysis of intestinal motility,
what causes an ileus
handling of bowel, peritonitis, retropertioneal injury, immobilisation, hypokalaemia, drugs
how does an ileus present
vomiting, abdo distention, dehydration, silent abdomen
how is an ileus prevented
minimal operative trauma, laparoscopy, avoidance of intrabdominal spesis
what is anastomotic dehiscence
breakdown of anastomosis (intestinal, vascular, urological)
what causes a anastomotic dehiscence
poor technique, poor blood supply, tension on anastomoses
how does an intetsinal anastomotic dehiscence present
perionitis, abscess, ileus, fistula
how does a vascular anastomotic dehiscence present
bleeding, haemorrhage
how does a urological anastomotic dehiscence present
leakage or urine/ urinoma
how are anastomotic dehiscence prevented
good technique and blood supply, no tension
what are adhesions and give examples
fibrin turns into fibrous tissue
- bowel to bowel
- bowel to abdo wall/ other structures
- lung to chest
what causes adhesion
inflammatory response, ischaemia
how do adhesions present
asymptomatic (to chest wall)
intestinal obstruction (vomiting, pain, distention, constipation)
how are adhesions prevented
no powder on gloves
avoidance of infection
laparoscopic surgery
sodium hyaluronidate
what are the wound complications
infections, dehiscence, hernia
what are the exogenous and endogenous causes of wound infections
trauma- exogenous
intestinal surgery- endogenous
how do wound infections present
pyrexia (5-8 days) redness, pain, swelling, discharge
how are wound infections prevented
pre-op prep, skin cleaning, aseptic technique, avoidance of contaminants, prophylactic antibiotics
what are the urinary complications
acute retention of urine,
urinary tract infection,
urethral structure,
acute renal failure
what are the neurological complications
confusion,
stroke,
peripheral nerve lesions
what can cause confusion
hypoxia (chest infection, PE, MI), oversedation, sepsis, electrolyte imbalance, stroke, hyper or hypoglycaemia, alcohol or tranquilliser withdrawal
how does confusion present
disorientation (time, place),
paranoia,
hallucinations
how is confusion avoided
maintain oxygenation,
avoid dehydration,
avoid sepsis,
send home ASAP
what are the objectives of enhanced recovery after surgery
to minimise post op complications and return patient to normality ASAP promote -pain control -GI function -mobility
