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Junior Surgery > Exam 2 - Surgical Complications > Flashcards

Exam 2 - Surgical Complications Flashcards

1
Q

The ______ surgeon knows how to operate. ______ surgeons know when to operate. The _____ surgeons know when not to operate.

A

Average, good, best

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2
Q

What components about an exploratory celiotomy can result in complications?

A

Incision, anesthesia, procedure

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3
Q

What may the owner want to know when you discuss a patient’s problem and options for repair?

A

Owner often wants percentage of success
Owner wants options
Owner may not choose the medically ‘best’ option

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4
Q

What complications about a procedure should you discuss with a client?

A

Infection, incisional problems, problems related to the specific surgery, anesthetic complications, and death

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5
Q

What do you need to make sure to get from the owner before preceding into surgery?

A

written owner consent

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6
Q

What pre-operative considerations need to be considered in cases of surgical emergency?

A

Extent of trauma

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7
Q

What pre-operative considerations need to be considered about the patients body condition?

A

Whether or not they are malnourished or overweight

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8
Q

Dysfunctions in which body systems need to be considered pre-operatively?

A

Dysfunctions in the cardiac system, pulmonary system, renal system, liver system, and bleeding disorders

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9
Q

What about the animal’s role should be considered pre-operatively?

A

performance, show, competition

The owner’s expectations will be affected

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10
Q

What is a very important step that needs to be done to a patient prior to surgery?

A

History and physical exam

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11
Q

True or False: Medications have no affect on surgical options.

A

false

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12
Q

What questions need to be asked about home care and client compliance prior to surgery?

A

Is the owner willing to confine the pet?

Is the owner able to perform wound care? Change bandages?

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13
Q

How can diabetes affect a surgery?

A

it affects healing rate, and there are skin issues associated with it

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14
Q

How can sepsis affect a surgery?

A

It can cause SIRS, MODS, and DIC

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15
Q

True or False: If a patient is in shock you need to stabilize them before taking them to surgery.

A

True

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16
Q

What is an example of an electrolyte imbalance that you may need to correct prior to surgery?

A

hyperkalemia

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17
Q

How can dehydration be managed pre-operatively and during surgery?

A

fluid therapy

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18
Q

What are the most common intra-operative complications?

A

Hemorrhage, inadequate ventilation or perfusion, hypothermia, inadvertent damage to tissues

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19
Q

Where can hemorrhage occur during an OHE?

A

Subcutaneous issue, muscle fibers, ovarian pedicles, uterine vessels, broad ligament, spleen, mesentery, and bladder

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20
Q

True or False: Prevention is easier than trying to control hemorrhage.

A

True - duh I know

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21
Q

How do you avoid inadvertent trauma to other abdominal organs during surgery?

A

Evaluate the linea alba, face the scalpel blade up, and evaluate the peritoneum

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22
Q

How do you manage splenic lacerations?

A

Suture the capsule with 3-0 or 4-0 using a simple continuous or interrupted; use care

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23
Q

How do you manage bladder lacerations?

A

Suture them with 3-0 using a simple continuous or interrupted

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24
Q

How do you manage mesenteric tears?

A

Suture with 3-0 - if it affects blood supply to the bowel you may need to resect

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25
Q

How do you avoid hemorrhage when manipulating the ovarian pedicles?

A

Avoid with careful ligature placement and be careful when breaking down the suspensory ligament

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26
Q

If an ovarian pedicle is bleeding after you release it, what must you do?

A

Retrieve it and ligate it - you may need to extend the incision

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27
Q

How would you go about finding the right ovarian pedicle?

A

reflect the duodenum to the left and expose the caudal pole of the right kidney

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28
Q

How would you go about finding the left ovarian pedicle?

A

reflect the descending colon to the right and expose the caudal pole of the left kidney

29
Q

What is often the cause of hemorrhage during an orchiectomy?

A

from insecure ligatures

30
Q

How do you manage a hemorrhage during an orchiectomy?

A

Identify the pedicle, enlarge the incision if needed to find the pedicle, place forceps, and replace ligatures

31
Q

What complications can occur with the incision?

A

Pain, swelling, seroma, infection, dehiscence, and suture reactions

32
Q

Aside from incisional complications, what other post-operative complications can occur during OHE?

A

Ileus, adhesions, peritonitis, scrotal hematoma (in an orchiectomy), and ovarian remnant

33
Q

What are some signs of incisional infections?

A

Heat, pain, redness, and discharge

34
Q

What can reduce the risk of incisional infection?

A

Aseptic technique and surgical duration duration of less than an hour

35
Q

What layers do most incisional infections involve?

A

Only the superficial layers

36
Q

How can you treat incisional infections?

A

Broad-spectrum antibiotics, drainage, local wound care, and to prevent self-trauma

37
Q

What can be done to prevent self trauma?

A

E-collar and bandages

38
Q

If there is drainage in an incisional infection, what needs to happen?

A

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

39
Q

What is there an increased risk of in cases of incisional infection?

A

there is an increased risk for hernia

40
Q

Where does the most serious incisional dehiscence occur?

A

at the body wall

41
Q

What is incisional dehiscence the result of?

A

Insecure knots, suturing body wall on one side to subcutaneous tissue on the other side
Taking bites that are too small

42
Q

If incisional dehiscence is an emergency, what needs to be done?

A

Clean the exposed abdominal contents, repairing any damaged tissue, lavage of the abdominal cavity, closure and antibiotics

43
Q

When can incisional hernias occur?

A

acutely or several weeks after surgery

44
Q

If there is an incisional hernia, what should be done?

A

If acutely, repair during surgery

The hernia needs to be palpated and ultrasounded

45
Q

True or False: Ventral midline post operative complications, especially hernias, in the horse will often need surgical repair?

A

True

46
Q

What can be done to temporarily manage hernias in horses?

A

Belly bandages/pressure bandages

47
Q

When should repair ideally occur in equine post-operative complications?

A

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.

48
Q

When do scrotal hematomas typically occur?

A

Within 24 hours of surgery

49
Q

How are scrotal hematomas medically treated?

A

With ice and anti-inflammatories

50
Q

How are scrotal hematomas surgically treated?

A

Scrotal ablation

51
Q

How do you prevent scrotal hematomas?

A

make sure that all of the bleeding is controlled

52
Q

What is ileus and when does it typically occur?

A

It is the lack of appropriate GI motility that usually occurs within 24 hours of surgery

53
Q

What are the types of ileus?

A

focal or generalized, functional or obstructive

54
Q

What can cause ileus?

A

Drugs, peritonitis, intestinal distension, electrolyte imbalance, intestinal obstruction, etc.

55
Q

How is ileus treated?

A

IV fluids, analgesics, prokinetics, and supportive care

56
Q

How is ileus treated if it is obstructive?

A

with surgery

57
Q

What clinical signs are associated with peritonitis?

A

fever, vomiting, diarrhea, anorexia, and pain

58
Q

What is the most common cause of peritonitis?

A

Leakage of gastrointestinal surgery sites such as dehiscence of small intestine in dogs

59
Q

What is the mortality rate of peritonitis caused by leakage of gastrointestinal surgery sites?

A

70%

60
Q

Aside from leakage of gastrointestinal surgery sites, what else can cause peritonitis?

A

foreign body reaction

61
Q

How can peritonitis be prevented?

A

Good surgical technique, keep viscera moist, pack off the abdomen, and abdominal lavage

62
Q

How is peritonitis treated?

A

Supportive care, antibiotics, surgery, and drains

63
Q

What is a major sign that there is an ovarian remnant?

A

The animal will come into estrus after OHE

64
Q

If you do a vaginal cytology in a patient that has an ovarian remnant, what will you see?

A

cornified epithelial cells predominate

65
Q

What other things can be done to confirm ovarian remnants?

A

Ultrasound and progesterone assays

66
Q

How are ovarian remnants treated and when is it easiest to do?

A

Surgical removal of ovarian tissue - they are easiest to perform when the animal is in estrus

67
Q

What is the most common cause of ovarian remnant syndrome in dogs and cats?

A

There was a surgical error

68
Q

True or False: Signs of ovarian remnant syndrome such as estrus and proestrus are often immediate.

A

False - signs can be delayed - even up to 10 years

69
Q

How do you prevent ovarian remnants?

A

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

Junior Surgery (17 decks)

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