GI Surgery and Complications Flashcards
cardiovascular complications of surgery
haemorrhage
MI
DVT
types of haemorrhage due to complications of surgery
reactionary
secondary
when would reactionary haemorrhage occur
immediate postoperative
when would secondary haemorrhage occur
infection; 5-10 days
presentation of haemorrhage
overt
tachycardia
hypotension
oliguria
outcome of haemorrhage
blood loss
fluid restriction
prevention of haemorrhage
meticulous technique
avoidance of sepsis
correction of coagulation disorders
presentation of MI post-op
silent
cardiac failure/caridogenic shock
arrhythmias
prevention of MI
delay surgery after MI
avoidance of preoperative hypertension
correction of ischaemic heart disease
risk factors of DVT
age > 40 hx DVT majory surgery obese malignancy
causes of DVT
immobility during surgery
hypercoagulable state
presentation of DVT
low grade fever unilateral ankle swelling calf of thigh tenderness increased leg diameter shiny skin
tests for DVT
D-dimer - low risk
doppler ultrasound
venography
prevention of DVT
compression stockings
low-dose subcutaneous heparin
early mobilisation
respiratory complications of surgery
atelectasis
pneumonia
PE
risks factors of surgery predisposing patient to atelectasis/pneumonia
collapse of lung tissue
anaesthesia
post-op pain
aspiration
how is anaesthesia a respiratory risk factor for post-op
increases secretion
inhibits cilia
how is
how is post-op pain a respiratory risk factor for post-op
inhibits coughing
presentation of post-op chest infection
low Grade fever - 0-2 days high grade fever - 4-10 days dyspnoea productive cough confusion
prevention of chest infection
stop smoking
adequate analgesia
physiotherapy
risk factors of PE
age > 40 hx PE major surgery obesity malignancy
causes of PE
DVT
presentation of PE
tachypnoea dyspnoea confusion pleuritic pain haemoptysis cardiopulmonary arrest
tests for PE
CT pulmonary angiogram - first line
V/Q scan
prevention of PE
compression stockings
low-dose subcutaneous heparin
early mobilisation
anticoagulation in presence of DVT
GI complications of surgery
ileus
anastomotic dehiscence
adhesions
what is ileus
paralysis of intestinal motility
causes of ileus
handling of bowel peritonitis retroperitoneal injury immobilisation hypokalaemia drugs
presentation of ileus
vomiting
abdominal distension
dehydration
silent abdomen
prevention of ileus
minimal operative trauma
laparoscopy
avoidance of intra-abdominal sepsis
what is anastomotic dehiscence
breakdown of anastomosis;
intestinal
vascular
urological
causes of anastomotic dehiscence
poor technique
poor blood supply
tension on anastomosis
intestinal presentation of anastomotic dehiscence
peritonitis
abscess
ileus
fistula
vascular presentation of anastomotic dehiscence
bleeding/haemorrhage
urological presentation of anastomotic dehiscence
leakage of urine/urinoma
prevention of anastomotic dehiscence
good technique
good blood supply
tension
what are adhesions
when fibrin turns into fibrous tissue
where are adhesions in chest/abdomen
bowel to bowel
bowel to abdominal wall and other structures
lung to chest wall
causes of adhesions
inflammatory response
ischaemia
presentation of adhesions
asymptomatic (chest wall)
intestinal obstruction
symptoms of intestinal obstruction
vomiting
pain
distension
constipation
prevention of adhesions
no powder on gloves
avoidance of infection
laparoscopic surgery
sodium hyaluronidate
types of wound infection
trauma - exogenous
intestinal surgery - endogenous
presentation of wound infection
pyrexia redness pain swelling discharge
prevention of wound infection
pre-op preparation skin cleansing aseptic technique avoidance of contamination prophylactic antibiotics
urinary complications of surgery
acute retention of urine
UTI
urethral stricture
acute renal failure
neurological complications of surgery
confusion
stroke
peripheral nerve lesions
causes of confusion post-op
hypoxia over sedation sepsis electrolyte imbalance stroke hyper/hypoglyceamia alcohol or tranquilliser withdrawal
presentation of confusion
disorientation - time and place
paranoia
hallucinations
prevention of confusion
maintain oxygenation
avoid dehydration
avoid sepsis
what is ERAS
enhanced recovery after surgery - a multimode programme of enhanced care to minimise post-op complications and return patient to normality ASAP
objectives of ERAS
promotes;
pain control
GI function
mobility
