GI Misc. 7 - GI surgery complicaitons

Question 1

What are the 2 possible types of postoperative complications?

Answer 1

General (any operation)Specific (this operation)

Question 2

Main CV complications of any operation?

Answer 2

HaemorrhageMI (mainly if the patient has history of this)DVT

Question 3

What are the 2 types of haemorrhages - postoperative complications?

Answer 3

Reactionary (immediately pos-operative e.g. if not tied vessels properly)Secondary (related to infection - 5-10 days post-surgery)

Question 4

How does a haemorrhage present? (3)

Answer 4

Normally can’t see it as inside a cavity:Tachycardiahypotensionoliguria (poor urine output)

Question 5

Haemorrhage prevention? (3)

Answer 5

Meticulous technique in surgeryAvoidance of sepsisCorrection of coagulation disorders

Question 6

2 types of MI related to surgery?

Answer 6

Post-operativePeri-operative

Question 7

What causes an increased risk of having a peri-post-operative MI?

Answer 7

Severe anginaPrevious MI

Question 8

What are the symptoms of a peri/post-operative MI?

Answer 8

Often silent when peri-operativecardiac failure/ cardiogenic shockArrhythmias

Question 9

How to prevent a peri/post-operative MI?

Answer 9

Delay surgery after MIAvoidance of preoperative hypotensionCorrection of ischaemic heart disease

Question 10

What are the risk factors for a DVT?

Answer 10

Age > 40Previous DVTmajor surgeryObesitymalignancy

Question 11

What causes a DVT during/ after surgery?

Answer 11

Immobility during surgeryHyper-coagulable state

Question 12

How does a DVT present?

Answer 12

Low grade fever (5-14 days)Unilateral ankle swellingCalf or thigh tendernessIncreased leg diameterShiny skin

Question 13

Investigations for a DVT?

Answer 13

D-dimer test (good rule-out test)If D-dimer abnormal, Doppler USVenography(if you think they have a DVT, start them on heparin)

Question 14

How to prevent DVT?

Answer 14

Compression stockingsLow-dose subcutaneous heparinEarly mobilisation

Question 15

3 main respiratory surgery complications?

Answer 15

AtelectasisPenumoniaPE

Question 16

Atelectasis?

Answer 16

Collapse of lung tissue which leads to infection (pneumonia)

Question 17

How does surgery lead to atelectasis/ pneumonia?

Answer 17

Anaesthesia = increases secretion, inhibits ciliaPostoperative pain = inhibits coughingAspiration = stomach contents

Question 18

How does a post-operative chest infection present?

Answer 18

Low grade fever (0-2 days)High grade fever (4-10 days)DyspnoeaProductive coughConfusion (due to hypoxia)

Question 19

How to prevent a chest infection?

Answer 19

Stopping smoking (even for a couple of days prior to surgery)Adequate analgesia (blocks pain = coughing, stronger analgesics can cause respiratory suppression)Physiotherapy

Question 20

What causes a PE?

Answer 20

A DVT (same risk factors as a DVT)

Question 21

How does a PE present?

Answer 21

TachypnoeaDyspnoeaConfusion (due to hypoxia)Pleuritic painHaemoptysisCardiopulmonary arrest

Question 22

What type of radionucletide is used in the ventilation part of the V/Q scan?

Answer 22

Inhaled gaseous radionuclide

Question 23

What type of radio nucleotide is used in the perfusion part of the VIQ scan?

Answer 23

Injection of albumin tagged with radionuclide

Question 24

What are the test for a PE?

Answer 24

Abnormal V/Q scanUsually perform a CTPA if you suspect a large PE

Question 25

Prevention of PE?

Answer 25

Same way as we prevent DVT:Compression stockingsEarly mobilisationIf DVT, anticoagulation Low-dose subcutaneous heparin

Question 26

Complications of GI surgery?

Answer 26

IleusAnastomotic dehiscence Adhesions

Question 27

What is ileus?

Answer 27

Paralysis of intestinal motility

Question 28

What is ileus caused by?

Answer 28

Handling of bowelPeritonitisRetroperitoneal injuryImmobilisation HypolalaemiaDrugs

Question 29

How does a patient with ileus present?

Answer 29

VomitingAbdominal distensionDehydrationSilent abdomen

Question 30

How is an ileus prevented?

Answer 30

Minimal operative traumaLaparoscopyAvoidance of intra-abdominal sepsis

Question 31

What is anastomotic dehiscence?

Answer 31

Breakdown of anastomosis:-intestinal-vascualar-urological

Question 32

What causes anastomotic dehiscence?

Answer 32

Poor techniquePoor blood supplyTension on anastomosis

Question 33

How does an intestinal anastomotic dehiscence present?

Answer 33

PeriotnitisAbscessIleusFistula

Question 34

How does a vascular anastomotic dehiscence present?

Answer 34

bleeding/ haematoma

Question 35

How does a urological anastomotic dehiscence present?

Answer 35

Leakage of urine/ urinoma

Question 36

prevention of an anastomotic dehiscence?

Answer 36

Good techniqueGood blood supplyNo tension

Question 37

What causes the deposition of fibrous tissue?

Answer 37

Any operation due to a combination of the inflammatory response and ischaemia

Question 38

Where can adhesions form in surgery?

Answer 38

Bowel to bowelBowel to abdominal wall and other structuresLung to chest wall

Question 39

What are the symptoms of a adhesion to the chest wall?

Answer 39

Asymptomatic

Question 40

What are the symptoms of an intestinal obstruction (due to adhesions)?

Answer 40

VomitingPainDistensionConstipation(depends on location)

Question 41

Prevention of adhesions?

Answer 41

No power on glovesAvoidance of infectionLaparoscopic surgerySodium hyaluronidate (slightly decreases the risk of adhesion formation)

Question 42

What are the 3 main complications regarding wounds?

Answer 42

InfectionDehiscenceHernia

Question 43

What tends to be the source of the bacteria for infection of a wound?

Answer 43

Intestinal contetns(Unusual to be caused by external environement)

Question 44

What type of patients tend to get an exogenous infection?

Answer 44

Trauma patients

Question 45

What type of patients tend to get an endogenous infection?

Answer 45

Intestinal surgery patients

Question 46

What are the symptoms of a wound infection?

Answer 46

Pyrexia (5-8 days)RednessPainSwellingDischarge

Question 47

Prevention of wound infection?

Answer 47

Pre-op preparation (e.g. bowel prep)Skin cleansingAseptic techniqueAvoidance of contaminationProphylactic antibiotics (single dose)

Question 48

What are the main urinary complications?

Answer 48

Acute retention of urineUrinary tract infectionurethral structureAcute renal failure

Question 49

What are the main neurological complicaitons?

Answer 49

ConfusionStrokePeripheral nerve lesions (ulnar, radial, sciatic, common peroneal nerves are easily compressed/ stretched) - be careful of positioning patients in surgery

Question 50

Causes of confusion?

Answer 50

Hypoxia (most common cause - chest infection, PE, MI)OversedationSepsisElectrolyte imbalanceStrokeHyper or hypoglycaemiaAlcohol or tranquilliser withdrawl

Question 51

Confusion presentation?

Answer 51

Disorientation (time and place)ParanoiaHallucinations

Question 52

Confusion prevention?

Answer 52

Maintain oxygenationAvoid dehydrationAvoid sepsisSend home as soon as possible!

Question 53

How to minimise complications and their effect?

Answer 53

Patient selection and their effectCareful surgeryConstant vigilance

Question 54

What does ERAS stand for?

Answer 54

Enhanced Recovery affter surgery

Question 55

What are the objectives of ERAS?

Answer 55

To minimise post-operativecomplicaitons and return patient to normality ASAP by promoting pain control, GI function, mobility

Question 56

What are the 3 components of ERAS pathway?

Answer 56

Pre-opPeri-opPost-op