Gastrointestinal Post-Op Complications Flashcards
what are the common early post-op GI complications?
- ileus
- malabsorption
- post-op nausea and vomiting
what is an ileus?
decrease or complete arrest in gut motility following surgery
what are the risk factors for an ileus?
- intra-abdominal surgery
- opioid analgesia
- stress response
- sepsis
what are the clinical presentation of a post-operative ileus?
- failure to pass flatus or faeces
- sensation of bloating or distension
- nausea and vomiting
what are the clinical findings of a post-operative ileus?
- abdominal distension
- absent bowel sounds
what investigations can be done in a suspected post-op ileus?
- routine bloods
- CT scan of the abdo pelvis to confirm diagnosis
what is the management for a post-op ileus?
- encourage mobilisation
- reduce opiate analgesia
- using an NG tube to drain bowel contents
what can be done to prevent a post-op ileus?
- minimise intra-operative intestinal handling
- avoid fluid overload as can cause intestinal oedema
- minimise opiate use
- encourage early mobilisation
what is an anastomotic leak?
a leak of luminal contents from a surgical join
why is it so important to identify an anastomotic leak?
the longer it is left untreated, the more chance of contamination of the abdomen by the luminal contents
what is the worst complication of an anastomotic leak?
sepsis
true or false: a patient who is deteriorating after surgery is considered to have an anastomotic leak until proven otherwise
true.
what are the patient risk factors for an anastomotic leak?
- immunosuppressed
- smoking or alcohol excess
- diabetic
- obesity or malnutrition
what are the surgical risk factors for an anastomotic leak?
- emergency surgery
- loner intra-operative time
- peritoneal contamination
- oesophageal-gastric or rectal anastomoses
what are the clinical features of an anastomotic leak?
abdominal pain and fever presenting 5 to 7 days post operatively
what are the clinical signs of an anastomotic leak?
pyrexia
tachycardia
signs of peritonism (severe pain and swelling of the abdomen)
what investigations should be done in a patient with a suspected anastomotic leak?
CT abdo-pelvis which will show if there are any extra-luminal contents
Blood test: FBC, U&Es, CRP, LFTs, clotting screen, G&S and X-match
how would you initially manage a patient with an anastomotic leak?
put the patient on NBM status and begin broad spectrum antibiotic cover
begin IV fluid therapy and monitor fluid balance with catheter insertion
what is considered the definitive management of a minor anastomotic leak?
can be managed conservatively:
using IV antibiotics if small
percutaneous drainage if leak is >5cm
what is considered definitive management of a major anastomotic leak?
if the patient is septic or has multiple collections then an exploratory laparotomy is done - to washout with drain insertion
true or false: a colo-rectal anastomosis should be treated with a stoma
true.
what are bowel adhesions?
fibrous bands of scar tissue, most commonly due to previous surgery or intra-abdo inflammation
true or false: bowel adhesions are the most common cause of small bowel obstruction
true.
true or false: bowel adhesions tend to asymptomatic
true.
what are the major complications of bowel adhesions?
obstruction, female infertility, chronic pelvic pain
what is the management for bowel obstruction caused by adhesions?
if uncomplicated:
treat conservatively using an NG tube to decompress
patient is also kept NBM and given IV fluids and analgesia
what is the surgical management for bowel obstruction caused by adhesions?
adhesiolysis is only done if patient shows signs of ischaemia or perforation, or if conservative treatment failed.
it is also only done on adhesions causing the obstruction
what is an incisional hernia?
protrusion of the contents of the abdominal cavity through a previously made incision
why does an incisional hernia occur?
disruption of the continuity of the anterior abdominal wall muscles by a surgical incision results in structural weakness.
an increase in intra-abdominal pressure allows the abdominal contents to herniate through this weakness
what are the risk factors for an incisional hernia?
- emergency surgery
- wound and incision (midline) type
- obesity
- wound infection
- age
- pregnancy
- smoking
- connective tissue disorders
what are the clinical features of an incisional hernia?
non pulsatile, reducible, soft and non-tender swelling at or near the site of a previous surgical wound
what are the clinical features of an incarcerated incisional hernia?
painful, tender and erythematous
what would you find on examination of an incisional hernia?
palpable mass which may be reducible
if ischaemic: there may be rebound tenderness or guarding
what investigations would you do in a patient with a suspected incisional hernia?
diagnosis is made on clinical basis however USS or CT can be used to investigate
how would you manage an incisional hernia?
if asymptomatic: manage conservatively
if symptomatic: surgery is indicated
what is the clinical definition of constipation?
< 3 bowel movements a week, often with hard, dry stool, that may be difficult to pass
what are the causes of post-op constipation?
- physiological e.g. low fibre diet, low fluid intake
- iatrogenic e.g. medications like opioids
- pathological such as bowel obstruction
- functional such as painful defecation
what are the clinical presentation of post-op constipation?
lower abdominal pain
if severe can present with abdo distension, nausea and vomiting, loss of appetite
what are the clinical signs of post-op constipation?
a DRE is done to assess degree of faecal impaction
what investigations are done in a suspected post-op constipation?
usually made on a clinical diagnosis
imaging is only done if bowel obstruction is suspected
what is the management for a post-op constipation?
conservatively managed with laxatives
if resistant additional therapy can be done as manual evacuation or an enema
what preventative measures can be given for post-op constipation?
- opioid analgesia should be avoided
- prophylactic stimulant laxatives should be used if needed
