Exam 2 - Surgical Complications Flashcards
The ______ surgeon knows how to operate. ______ surgeons know when to operate. The _____ surgeons know when not to operate.
Average, good, best
What components about an exploratory celiotomy can result in complications?
Incision, anesthesia, procedure
What may the owner want to know when you discuss a patient’s problem and options for repair?
Owner often wants percentage of success
Owner wants options
Owner may not choose the medically ‘best’ option
What complications about a procedure should you discuss with a client?
Infection, incisional problems, problems related to the specific surgery, anesthetic complications, and death
What do you need to make sure to get from the owner before preceding into surgery?
written owner consent
What pre-operative considerations need to be considered in cases of surgical emergency?
Extent of trauma
What pre-operative considerations need to be considered about the patients body condition?
Whether or not they are malnourished or overweight
Dysfunctions in which body systems need to be considered pre-operatively?
Dysfunctions in the cardiac system, pulmonary system, renal system, liver system, and bleeding disorders
What about the animal’s role should be considered pre-operatively?
performance, show, competition
The owner’s expectations will be affected
What is a very important step that needs to be done to a patient prior to surgery?
History and physical exam
True or False: Medications have no affect on surgical options.
false
What questions need to be asked about home care and client compliance prior to surgery?
Is the owner willing to confine the pet?
Is the owner able to perform wound care? Change bandages?
How can diabetes affect a surgery?
it affects healing rate, and there are skin issues associated with it
How can sepsis affect a surgery?
It can cause SIRS, MODS, and DIC
True or False: If a patient is in shock you need to stabilize them before taking them to surgery.
True
What is an example of an electrolyte imbalance that you may need to correct prior to surgery?
hyperkalemia
How can dehydration be managed pre-operatively and during surgery?
fluid therapy
What are the most common intra-operative complications?
Hemorrhage, inadequate ventilation or perfusion, hypothermia, inadvertent damage to tissues
Where can hemorrhage occur during an OHE?
Subcutaneous issue, muscle fibers, ovarian pedicles, uterine vessels, broad ligament, spleen, mesentery, and bladder
True or False: Prevention is easier than trying to control hemorrhage.
True - duh I know
How do you avoid inadvertent trauma to other abdominal organs during surgery?
Evaluate the linea alba, face the scalpel blade up, and evaluate the peritoneum
How do you manage splenic lacerations?
Suture the capsule with 3-0 or 4-0 using a simple continuous or interrupted; use care
How do you manage bladder lacerations?
Suture them with 3-0 using a simple continuous or interrupted
How do you manage mesenteric tears?
Suture with 3-0 - if it affects blood supply to the bowel you may need to resect
How do you avoid hemorrhage when manipulating the ovarian pedicles?
Avoid with careful ligature placement and be careful when breaking down the suspensory ligament
If an ovarian pedicle is bleeding after you release it, what must you do?
Retrieve it and ligate it - you may need to extend the incision
How would you go about finding the right ovarian pedicle?
reflect the duodenum to the left and expose the caudal pole of the right kidney
How would you go about finding the left ovarian pedicle?
reflect the descending colon to the right and expose the caudal pole of the left kidney
What is often the cause of hemorrhage during an orchiectomy?
from insecure ligatures
How do you manage a hemorrhage during an orchiectomy?
Identify the pedicle, enlarge the incision if needed to find the pedicle, place forceps, and replace ligatures
What complications can occur with the incision?
Pain, swelling, seroma, infection, dehiscence, and suture reactions
Aside from incisional complications, what other post-operative complications can occur during OHE?
Ileus, adhesions, peritonitis, scrotal hematoma (in an orchiectomy), and ovarian remnant
What are some signs of incisional infections?
Heat, pain, redness, and discharge
What can reduce the risk of incisional infection?
Aseptic technique and surgical duration duration of less than an hour
What layers do most incisional infections involve?
Only the superficial layers
How can you treat incisional infections?
Broad-spectrum antibiotics, drainage, local wound care, and to prevent self-trauma
What can be done to prevent self trauma?
E-collar and bandages
If there is drainage in an incisional infection, what needs to happen?
The regions where there are drainage needs to be opened to allow for drainage, they need to be flushed, culture and sensitivity needs to be done if it doesn’t resolve
What is there an increased risk of in cases of incisional infection?
there is an increased risk for hernia
Where does the most serious incisional dehiscence occur?
at the body wall
What is incisional dehiscence the result of?
Insecure knots, suturing body wall on one side to subcutaneous tissue on the other side
Taking bites that are too small
If incisional dehiscence is an emergency, what needs to be done?
Clean the exposed abdominal contents, repairing any damaged tissue, lavage of the abdominal cavity, closure and antibiotics
When can incisional hernias occur?
acutely or several weeks after surgery
If there is an incisional hernia, what should be done?
If acutely, repair during surgery
The hernia needs to be palpated and ultrasounded
True or False: Ventral midline post operative complications, especially hernias, in the horse will often need surgical repair?
True
What can be done to temporarily manage hernias in horses?
Belly bandages/pressure bandages
When should repair ideally occur in equine post-operative complications?
The ideal repair would occur after fibrosis and scar tissue has formed (approximately 4-6 months after surgery). If the bowel is in danger of entrapment, you may have to repair sooner.
When do scrotal hematomas typically occur?
Within 24 hours of surgery
How are scrotal hematomas medically treated?
With ice and anti-inflammatories
How are scrotal hematomas surgically treated?
Scrotal ablation
How do you prevent scrotal hematomas?
make sure that all of the bleeding is controlled
What is ileus and when does it typically occur?
It is the lack of appropriate GI motility that usually occurs within 24 hours of surgery
What are the types of ileus?
focal or generalized, functional or obstructive
What can cause ileus?
Drugs, peritonitis, intestinal distension, electrolyte imbalance, intestinal obstruction, etc.
How is ileus treated?
IV fluids, analgesics, prokinetics, and supportive care
How is ileus treated if it is obstructive?
with surgery
What clinical signs are associated with peritonitis?
fever, vomiting, diarrhea, anorexia, and pain
What is the most common cause of peritonitis?
Leakage of gastrointestinal surgery sites such as dehiscence of small intestine in dogs
What is the mortality rate of peritonitis caused by leakage of gastrointestinal surgery sites?
70%
Aside from leakage of gastrointestinal surgery sites, what else can cause peritonitis?
foreign body reaction
How can peritonitis be prevented?
Good surgical technique, keep viscera moist, pack off the abdomen, and abdominal lavage
How is peritonitis treated?
Supportive care, antibiotics, surgery, and drains
What is a major sign that there is an ovarian remnant?
The animal will come into estrus after OHE
If you do a vaginal cytology in a patient that has an ovarian remnant, what will you see?
cornified epithelial cells predominate
What other things can be done to confirm ovarian remnants?
Ultrasound and progesterone assays
How are ovarian remnants treated and when is it easiest to do?
Surgical removal of ovarian tissue - they are easiest to perform when the animal is in estrus
What is the most common cause of ovarian remnant syndrome in dogs and cats?
There was a surgical error
True or False: Signs of ovarian remnant syndrome such as estrus and proestrus are often immediate.
False - signs can be delayed - even up to 10 years
How do you prevent ovarian remnants?
Adequate exposure, careful palpation of ovary before forceps placement and transection, and open the ovarian bursa after OHE to make sure the entire ovary has been removed
