GI Post-Op Nursing

Question 1

What are the possible immediate post-op complications (hours)?

Answer 1

Physiological abnormalities worsening (hypothermia etc.)
Pain
Haemorrhage
Drug/anaesthetic reaction
Vomiting/regurgitation
Trauma/increase in abdominal pressure, causing acute wound breakdown

Question 2

What are the possible long-term post-op complications (days)?

Answer 2

Pain
Haemorrhage
Aspiration pneumonia
Ileus
Infection of wound or interference

Question 3

Describe skin/cutaneous dehiscence.

Answer 3

Seen immediately post-op if trauma occurs, up to several weeks later
Usually 4-5 days post-op
Clinical signs = serosanguinous/prurulent discharge from suture line, swelling and bruising/necrosis of edges

Question 4

Describe abdominal wall dehiscence.

Answer 4

Dehiscence of abdominal muscles underneath wound, essentially creating a hernia
Overlying skin remains intact but deeper layers have separated
Usually within first 7 days (but can be weeks or years after surgery)
Clinical signs = wound oedema/inflammation, serosanguinous drainage from incision, painless swelling

Question 5

Describe intestinal dehiscence.

Answer 5

Dehiscence after enteric suture leads to septic peritonitis
Usually occurs within 2-5 days post-op
Clinical signs = depression, anorexia, vomiting, abdominal pain, acute collapse

Question 6

What are the risk factors for dehiscence?

Answer 6

Surgical technique
Self-trauma
Underlying neoplasia of area
Closure of non-viable skin
Systemic factors (endocrine disease, obesity, hypoproteinaemia/hypovolaemia etc.)

Question 7

How can we prevent dehiscence?

Answer 7

Bandaging to immobilise areas of excessive motion
Elizabethan collar to prevent self-trauma
Animal confined and exercise-restricted for 2 weeks

Question 8

What are the two types of secondary peritonitis?

Answer 8

Aseptic = mild reaction to surgery itself, or if a sterile object is left in
Septic = most common type seen in small animals, contamination during surgery

Question 9

Why does peritonitis occur?

Answer 9

Dehiscence, ischaemic necrosis, leakage during surgery, insufficient lavage, infection through technique, leaving something in the patient
Emergencies - non-ideal pre-op prep, faecal matter/fluid/food present in intestines resulting in contamination

Question 10

How does peritonitis present?

Answer 10

Vague history of anorexia, vomiting/lethargy, pyrexia or acute collapse
May adopt prayer position
Rarely large volume of effusion so cannot rely on abdominal distension
3-5 days post-op most likely time to present - close monitoring!

Question 11

What problems can we see in the oesophagus?

Answer 11

Regurgitation
Oesophagitis
Strictures - post-op due to damage to mucosa that scars as it heals

Question 12

What problems can we see with the stomach?

Answer 12

Vomiting
Anorexia
Ulceration
Gastric outlet obstruction (e.g. strictures at pylorus)
Pancreatitis

Question 13

What gastric surgeries are common in first opinion?

Answer 13

Gastrotomy - foreign bodies

GDV - gastropexy

Question 14

What problems can we see with the small intestine?

Answer 14

Excessive handling/rough technique = serosal/peritoneal adhesions
Ileus
Perforation
Stenosis (constriction of lumen)
Intestinal strictures (rare)
Diarrhoea
Anorexia

Question 15

What small intestinal surgeries are common in first opinion?

Answer 15

Enterotomy - foreign body

Enterectomy - following foreign body or intussusception

Question 16

What problems can we see with the large intestine?

Answer 16

Haemorrhage and faecal contamination during surgery
Leakage
Strictures
Stenosis
Incontinence (rare)

Question 17

What problems can we see with the perineum, rectum and anus?

Answer 17

Tenesmus
Rectal prolapse
Temporary/permanent incontinence
Anal stricture
Urethral obstruction
Stenosis

Question 18

What rectal surgeries are common in first opinion?

Answer 18

Anal sacculectomy (removal of one/both anal sacs)

Question 19

What are the key things to monitor post-GI surgery?

Answer 19

Depression
Pyrexia
Abdominal tenderness
Vomiting
Anorexia
Wound

Question 20

What are the aims of a post-op care plan?

Answer 20

Restore hydration, maintain electrolyte status
Resume normal feeding and gut motility
Manage GI effects e.g. nausea
Manage pain
Prevent infection

Question 21

How do we manage hydration?

Answer 21

Most require fluids post-op until eating/drinking a normal amount
Especially important if biochemical/electrolyte abnormalities or ongoing fluid losses
Monitor for over-hydration - MMs, skin tent, crackles on auscultation
May be necessary to monitor fluid inputs and outputs

Question 22

How do we manage nutrition?

Answer 22

Intestinal/rectal/anal surgery patients encouraged to eat ASAP
Gastric/oesophageal start with water 2hrs post-op, then food attempted 12hrs later (risk of vomiting)
Bland diet, high calorie, little and often
Encourage patients to be ambulatory to help gut motility
Feeding tube - own complications but great for ensuring nutrition
Cats particularly reluctant to eat!

Question 23

How do we manage nausea?

Answer 23

Signs = salivation, repeated swallowing, lip-licking

Useful drugs = maropitant, metoclopramide, ranitidine, sucralfate, omeprazole

Question 24

What drugs may be useful post-GI surgery?

Answer 24

Prokinetic agents (metoclopramide) to manage ileus
Probiotics, fibre products useful for diarrhoea
Appetite stimulants (mirtazapine) useful in cats

Question 25

How can we manage pain?

Answer 25

NSAIDs - case basis, can cause ulceration/GI upset
Opioids - often used, may effect gut motility so weigh up when to wean off and move to alternative analgesia for going home
(Codeine, Paracetamol (dogs only!!), Tramadol)

Question 26

How do we manage infection?

Answer 26

Antibiotics most likely given peri-operatively
Discontinues 6-12hrs post-op, unless contaminated surgery/systemic illness
Broad spectrum e.g. amoxy-clavulanic acid