GI Misc. - Postoperative Complications Flashcards
What are the 2 possible types of postoperative complications?
General (any operation)
Specific (this operation)
Main CV complications of any operation?
Haemorrhage
MI (mainly if the patient has history of this)
DVT
What are the 2 types of haemorrhages - postoperative complications?
Reactionary (immediately pos-operative e.g. if not tied vessels properly)
Secondary (related to infection - 5-10 days post-surgery)
How does a haemorrhage present? (3)
Normally can’t see it as inside a cavity:
Tachycardia
hypotension
oliguria (poor urine output)
Haemorrhage prevention? (3)
Meticulous technique in surgery
Avoidance of sepsis
Correction of coagulation disorders
2 types of MI related to surgery?
Post-operative
Peri-operative
What causes an increased risk of having a peri-post-operative MI?
Severe angina
Previous MI
What are the symptoms of a peri/post-operative MI?
Often silent when peri-operative
cardiac failure/ cardiogenic shock
Arrhythmias
How to prevent a peri/post-operative MI?
Delay surgery after MI
Avoidance of preoperative hypotension
Correction of ischaemic heart disease
What are the risk factors for a DVT?
Age > 40 Previous DVT major surgery Obesity malignancy
What causes a DVT during/ after surgery?
Immobility during surgery
Hyper-coagulable state
How does a DVT present?
Low grade fever (5-14 days) Unilateral ankle swelling Calf or thigh tenderness Increased leg diameter Shiny skin
Investigations for a DVT?
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)
How to prevent DVT?
Compression stockings
Low-dose subcutaneous heparin
Early mobilisation
3 main respiratory surgery complications?
Atelectasis
Penumonia
PE
Atelectasis?
Collapse of lung tissue which leads to infection (pneumonia)
How does surgery lead to atelectasis/ pneumonia?
Anaesthesia = increases secretion, inhibits cilia
Postoperative pain = inhibits coughing
Aspiration = stomach contents
How does a post-operative chest infection present?
Low grade fever (0-2 days) High grade fever (4-10 days) Dyspnoea Productive cough Confusion (due to hypoxia)
How to prevent a chest infection?
Stopping smoking (even for a couple of days prior to surgery) Adequate analgesia (blocks pain = coughing, stronger analgesics can cause respiratory suppression) Physiotherapy
What causes a PE?
A DVT (same risk factors as a DVT)
How does a PE present?
Tachypnoea Dyspnoea Confusion (due to hypoxia) Pleuritic pain Haemoptysis Cardiopulmonary arrest
What type of radionucletide is used in the ventilation part of the V/Q scan?
Inhaled gaseous radionuclide
What type of radio nucleotide is used in the perfusion part of the VIQ scan?
Injection of albumin tagged with radionuclide
What are the test for a PE?
Abnormal V/Q scan
Usually perform a CTPA if you suspect a large PE
Prevention of PE?
Same way as we prevent DVT: Compression stockings Early mobilisation If DVT, anticoagulation Low-dose subcutaneous heparin
Complications of GI surgery?
Ileus
Anastomotic dehiscence
Adhesions
What is ileus?
Paralysis of intestinal motility
What is ileus caused by?
Handling of bowel Peritonitis Retroperitoneal injury Immobilisation Hypolalaemia Drugs
How does a patient with ileus present?
Vomiting
Abdominal distension
Dehydration
Silent abdomen
How is an ileus prevented?
Minimal operative trauma
Laparoscopy
Avoidance of intra-abdominal sepsis
What is anastomotic dehiscence?
Breakdown of anastomosis:
- intestinal
- vascualar
- urological
What causes anastomotic dehiscence?
Poor technique
Poor blood supply
Tension on anastomosis
How does an intestinal anastomotic dehiscence present?
Periotnitis
Abscess
Ileus
Fistula
How does a vascular anastomotic dehiscence present?
bleeding/ haematoma
How does a urological anastomotic dehiscence present?
Leakage of urine/ urinoma
prevention of an anastomotic dehiscence?
Good technique
Good blood supply
No tension
What causes the deposition of fibrous tissue?
Any operation due to a combination of the inflammatory response and ischaemia
Where can adhesions form in surgery?
Bowel to bowel
Bowel to abdominal wall and other structures
Lung to chest wall
What are the symptoms of a adhesion to the chest wall?
Asymptomatic
What are the symptoms of an intestinal obstruction (due to adhesions)?
Vomiting Pain Distension Constipation (depends on location)
Prevention of adhesions?
No power on gloves
Avoidance of infection
Laparoscopic surgery
Sodium hyaluronidate (slightly decreases the risk of adhesion formation)
What are the 3 main complications regarding wounds?
Infection
Dehiscence
Hernia
What tends to be the source of the bacteria for infection of a wound?
Intestinal contetns (Unusual to be caused by external environement)
What type of patients tend to get an exogenous infection?
Trauma patients
What type of patients tend to get an endogenous infection?
Intestinal surgery patients
What are the symptoms of a wound infection?
Pyrexia (5-8 days) Redness Pain Swelling Discharge
Prevention of wound infection?
Pre-op preparation (e.g. bowel prep) Skin cleansing Aseptic technique Avoidance of contamination Prophylactic antibiotics (single dose)
What are the main urinary complications?
Acute retention of urine
Urinary tract infection
urethral structure
Acute renal failure
What are the main neurological complicaitons?
Confusion
Stroke
Peripheral nerve lesions (ulnar, radial, sciatic, common peroneal nerves are easily compressed/ stretched) - be careful of positioning patients in surgery
Causes of confusion?
Hypoxia (most common cause - chest infection, PE, MI) Oversedation Sepsis Electrolyte imbalance Stroke Hyper or hypoglycaemia Alcohol or tranquilliser withdrawl
Confusion presentation?
Disorientation (time and place)
Paranoia
Hallucinations
Confusion prevention?
Maintain oxygenation
Avoid dehydration
Avoid sepsis
Send home as soon as possible!
How to minimise complications and their effect?
Patient selection and their effect
Careful surgery
Constant vigilance
What does ERAS stand for?
Enhanced Recovery affter surgery
What are the objectives of ERAS?
To minimise post-operativecomplicaitons and return patient to normality ASAP by promoting pain control, GI function, mobility
What are the 3 components of ERAS pathway?
Pre-op
Peri-op
Post-op
