GI Surgery and Complications

Question 1

cardiovascular complications of surgery

Answer 1

haemorrhage
MI
DVT

Question 2

types of haemorrhage due to complications of surgery

Answer 2

reactionary

secondary

Question 3

when would reactionary haemorrhage occur

Answer 3

immediate postoperative

Question 4

when would secondary haemorrhage occur

Answer 4

infection; 5-10 days

Question 5

presentation of haemorrhage

Answer 5

overt
tachycardia
hypotension
oliguria

Question 6

outcome of haemorrhage

Answer 6

blood loss

fluid restriction

Question 7

prevention of haemorrhage

Answer 7

meticulous technique
avoidance of sepsis
correction of coagulation disorders

Question 8

presentation of MI post-op

Answer 8

silent
cardiac failure/caridogenic shock
arrhythmias

Question 9

prevention of MI

Answer 9

delay surgery after MI
avoidance of preoperative hypertension
correction of ischaemic heart disease

Question 10

risk factors of DVT

Answer 10

age > 40
hx DVT
majory surgery 
obese 
malignancy

Question 11

causes of DVT

Answer 11

immobility during surgery

hypercoagulable state

Question 12

presentation of DVT

Answer 12

low grade fever 
unilateral ankle swelling 
calf of thigh tenderness 
increased leg diameter 
shiny skin

Question 13

tests for DVT

Answer 13

D-dimer - low risk
doppler ultrasound
venography

Question 14

prevention of DVT

Answer 14

compression stockings
low-dose subcutaneous heparin
early mobilisation

Question 15

respiratory complications of surgery

Answer 15

atelectasis
pneumonia
PE

Question 16

risks factors of surgery predisposing patient to atelectasis/pneumonia

Answer 16

collapse of lung tissue
anaesthesia
post-op pain
aspiration

Question 17

how is anaesthesia a respiratory risk factor for post-op

Answer 17

increases secretion
inhibits cilia
how is

Question 18

how is post-op pain a respiratory risk factor for post-op

Answer 18

inhibits coughing

Question 19

presentation of post-op chest infection

Answer 19

low Grade fever - 0-2 days
high grade fever - 4-10 days 
dyspnoea 
productive cough 
confusion

Question 20

prevention of chest infection

Answer 20

stop smoking
adequate analgesia
physiotherapy

Question 21

risk factors of PE

Answer 21

age > 40
hx PE
major surgery 
obesity
malignancy

Question 22

causes of PE

Answer 22

DVT

Question 23

presentation of PE

Answer 23

tachypnoea 
dyspnoea 
confusion 
pleuritic pain 
haemoptysis 
cardiopulmonary arrest

Question 24

tests for PE

Answer 24

CT pulmonary angiogram - first line

V/Q scan

Question 25

prevention of PE

Answer 25

compression stockings low-dose subcutaneous heparin early mobilisation anticoagulation in presence of DVT

Question 26

GI complications of surgery

Answer 26

ileus anastomotic dehiscence adhesions

Question 27

what is ileus

Answer 27

paralysis of intestinal motility

Question 28

causes of ileus

Answer 28

``` handling of bowel peritonitis retroperitoneal injury immobilisation hypokalaemia drugs ```

Question 29

presentation of ileus

Answer 29

vomiting abdominal distension dehydration silent abdomen

Question 30

prevention of ileus

Answer 30

minimal operative trauma laparoscopy avoidance of intra-abdominal sepsis

Question 31

what is anastomotic dehiscence

Answer 31

breakdown of anastomosis; intestinal vascular urological

Question 32

causes of anastomotic dehiscence

Answer 32

poor technique poor blood supply tension on anastomosis

Question 33

intestinal presentation of anastomotic dehiscence

Answer 33

peritonitis abscess ileus fistula

Question 34

vascular presentation of anastomotic dehiscence

Answer 34

bleeding/haemorrhage

Question 35

urological presentation of anastomotic dehiscence

Answer 35

leakage of urine/urinoma

Question 36

prevention of anastomotic dehiscence

Answer 36

good technique good blood supply tension

Question 37

what are adhesions

Answer 37

when fibrin turns into fibrous tissue

Question 38

where are adhesions in chest/abdomen

Answer 38

bowel to bowel bowel to abdominal wall and other structures lung to chest wall

Question 39

causes of adhesions

Answer 39

inflammatory response | ischaemia

Question 40

presentation of adhesions

Answer 40

asymptomatic (chest wall) | intestinal obstruction

Question 41

symptoms of intestinal obstruction

Answer 41

vomiting pain distension constipation

Question 42

prevention of adhesions

Answer 42

no powder on gloves avoidance of infection laparoscopic surgery sodium hyaluronidate

Question 43

types of wound infection

Answer 43

trauma - exogenous | intestinal surgery - endogenous

Question 44

presentation of wound infection

Answer 44

``` pyrexia redness pain swelling discharge ```

Question 45

prevention of wound infection

Answer 45

``` pre-op preparation skin cleansing aseptic technique avoidance of contamination prophylactic antibiotics ```

Question 46

urinary complications of surgery

Answer 46

acute retention of urine UTI urethral stricture acute renal failure

Question 47

neurological complications of surgery

Answer 47

confusion stroke peripheral nerve lesions

Question 48

causes of confusion post-op

Answer 48

``` hypoxia over sedation sepsis electrolyte imbalance stroke hyper/hypoglyceamia alcohol or tranquilliser withdrawal ```

Question 49

presentation of confusion

Answer 49

disorientation - time and place paranoia hallucinations

Question 50

prevention of confusion

Answer 50

maintain oxygenation avoid dehydration avoid sepsis

Question 51

what is ERAS

Answer 51

enhanced recovery after surgery - a multimode programme of enhanced care to minimise post-op complications and return patient to normality ASAP

Question 52

objectives of ERAS

Answer 52

promotes; pain control GI function mobility