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Study Notes - Gastroenterology > GI Misc. - Postoperative Complications > Flashcards

GI Misc. - Postoperative Complications Flashcards

1
Q

What are the 2 possible types of postoperative complications?

A

General (any operation)

Specific (this operation)

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2
Q

Main CV complications of any operation?

A

Haemorrhage
MI (mainly if the patient has history of this)
DVT

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3
Q

What are the 2 types of haemorrhages - postoperative complications?

A

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

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4
Q

How does a haemorrhage present? (3)

A

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

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5
Q

Haemorrhage prevention? (3)

A

Meticulous technique in surgery
Avoidance of sepsis
Correction of coagulation disorders

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6
Q

2 types of MI related to surgery?

A

Post-operative

Peri-operative

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7
Q

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

A

Severe angina

Previous MI

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8
Q

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

A

Often silent when peri-operative
cardiac failure/ cardiogenic shock
Arrhythmias

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9
Q

How to prevent a peri/post-operative MI?

A

Delay surgery after MI
Avoidance of preoperative hypotension
Correction of ischaemic heart disease

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10
Q

What are the risk factors for a DVT?

A 
Age > 40
Previous DVT
major surgery
Obesity
malignancy
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11
Q

What causes a DVT during/ after surgery?

A

Immobility during surgery

Hyper-coagulable state

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12
Q

How does a DVT present?

A 
Low grade fever (5-14 days)
Unilateral ankle swelling
Calf or thigh tenderness
Increased leg diameter
Shiny skin
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13
Q

Investigations for a DVT?

A

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

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14
Q

How to prevent DVT?

A

Compression stockings
Low-dose subcutaneous heparin
Early mobilisation

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15
Q

3 main respiratory surgery complications?

A

Atelectasis
Penumonia
PE

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16
Q

Atelectasis?

A

Collapse of lung tissue which leads to infection (pneumonia)

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17
Q

How does surgery lead to atelectasis/ pneumonia?

A

Anaesthesia = increases secretion, inhibits cilia
Postoperative pain = inhibits coughing
Aspiration = stomach contents

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18
Q

How does a post-operative chest infection present?

A 
Low grade fever (0-2 days)
High grade fever (4-10 days)
Dyspnoea
Productive cough
Confusion (due to hypoxia)
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19
Q

How to prevent a chest infection?

A 
Stopping smoking (even for a couple of days prior to surgery)
Adequate analgesia (blocks pain = coughing, stronger analgesics can cause respiratory suppression)
Physiotherapy
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20
Q

What causes a PE?

A

A DVT (same risk factors as a DVT)

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21
Q

How does a PE present?

A 
Tachypnoea
Dyspnoea
Confusion (due to hypoxia)
Pleuritic pain
Haemoptysis
Cardiopulmonary arrest
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22
Q

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

A

Inhaled gaseous radionuclide

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23
Q

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

A

Injection of albumin tagged with radionuclide

24
Q

What are the test for a PE?

A

Abnormal V/Q scan

Usually perform a CTPA if you suspect a large PE

25
Q

Prevention of PE?

A 
Same way as we prevent DVT:
Compression stockings
Early mobilisation
If DVT, anticoagulation 
Low-dose subcutaneous heparin
26
Q

Complications of GI surgery?

A

Ileus
Anastomotic dehiscence
Adhesions

27
Q

What is ileus?

A

Paralysis of intestinal motility

28
Q

What is ileus caused by?

A 
Handling of bowel
Peritonitis
Retroperitoneal injury
Immobilisation 
Hypolalaemia
Drugs
29
Q

How does a patient with ileus present?

A

Vomiting
Abdominal distension
Dehydration
Silent abdomen

30
Q

How is an ileus prevented?

A

Minimal operative trauma
Laparoscopy
Avoidance of intra-abdominal sepsis

31
Q

What is anastomotic dehiscence?

A

Breakdown of anastomosis:

  • intestinal
  • vascualar
  • urological
32
Q

What causes anastomotic dehiscence?

A

Poor technique
Poor blood supply
Tension on anastomosis

33
Q

How does an intestinal anastomotic dehiscence present?

A

Periotnitis
Abscess
Ileus
Fistula

34
Q

How does a vascular anastomotic dehiscence present?

A

bleeding/ haematoma

35
Q

How does a urological anastomotic dehiscence present?

A

Leakage of urine/ urinoma

36
Q

prevention of an anastomotic dehiscence?

A

Good technique
Good blood supply
No tension

37
Q

What causes the deposition of fibrous tissue?

A

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

38
Q

Where can adhesions form in surgery?

A

Bowel to bowel
Bowel to abdominal wall and other structures
Lung to chest wall

39
Q

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

A

Asymptomatic

40
Q

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

A 
Vomiting
Pain
Distension
Constipation
(depends on location)
41
Q

Prevention of adhesions?

A

No power on gloves
Avoidance of infection
Laparoscopic surgery
Sodium hyaluronidate (slightly decreases the risk of adhesion formation)

42
Q

What are the 3 main complications regarding wounds?

A

Infection
Dehiscence
Hernia

43
Q

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

A 
Intestinal contetns
(Unusual to be caused by external environement)
44
Q

What type of patients tend to get an exogenous infection?

A

Trauma patients

45
Q

What type of patients tend to get an endogenous infection?

A

Intestinal surgery patients

46
Q

What are the symptoms of a wound infection?

A 
Pyrexia (5-8 days)
Redness
Pain
Swelling
Discharge
47
Q

Prevention of wound infection?

A 
Pre-op preparation (e.g. bowel prep)
Skin cleansing
Aseptic technique
Avoidance of contamination
Prophylactic antibiotics (single dose)
48
Q

What are the main urinary complications?

A

Acute retention of urine
Urinary tract infection
urethral structure
Acute renal failure

49
Q

What are the main neurological complicaitons?

A

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

50
Q

Causes of confusion?

A 
Hypoxia (most common cause - chest infection, PE, MI)
Oversedation
Sepsis
Electrolyte imbalance
Stroke
Hyper or hypoglycaemia
Alcohol or tranquilliser withdrawl
51
Q

Confusion presentation?

A

Disorientation (time and place)
Paranoia
Hallucinations

52
Q

Confusion prevention?

A

Maintain oxygenation
Avoid dehydration
Avoid sepsis
Send home as soon as possible!

53
Q

How to minimise complications and their effect?

A

Patient selection and their effect
Careful surgery
Constant vigilance

54
Q

What does ERAS stand for?

A

Enhanced Recovery affter surgery

55
Q

What are the objectives of ERAS?

A

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

56
Q

What are the 3 components of ERAS pathway?

A

Pre-op
Peri-op
Post-op

Study Notes - Gastroenterology (42 decks)

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