GI surgery - post-op care Flashcards
what nutritional considerations should be made after GI surgery?
may require early or delayed post-op feeding
nutrition plan in place with awareness of animal’s preference and usual diet
careful monitoring of food intake
post-operative administration of anti-emetics, gastric protectants or motility agents
what wound considerations should be made post GI surgery?
ensure wound is appropriately dressed or covered, dry and frequently checked
ensure animal is positioned appropriately to minimise pressure on wound
prevent interference
what are the possible immediate post-op complications (within hours)?
physiological abnormalities worsening (hypothermia, hypovolaemia etc)
pain
haemorrhage
drug or anaesthetic reaction
vomiting/regurgitation
trauma or increase in abdominal pressure causing acute wound breakdown
what are the possible longer term post-op complications (days)?
pain haemorrhage aspiration pneumonia ileus infection of wound, interference
what is dehiscence?
the disruption of wounds edges - can refer to an organ or tissue
when is dehiscence usually seen?
most commonly seen at 3-5 days post-op - end of lag phase of healing
where are the 3 likely areas of dehiscence after GI surgery?
skin
abdominal wall
intestines
when does skin/cutaneous dehiscence usually happen?
4-5 days post-op
could be seen immediately if trauma occurs
what are the clinical signs of skin/cutaneous dehiscence?
serosanguinous or purulent discharge from suture line
swelling and bruising or necrosis of edges
what is abdominal wall dehiscence?
dehiscence of the abdominal muscles underneath a wound - creates a hernia
when does abdominal wall dehiscence typically occur?
usually within first 7 days (but can be weeks or years after surgery)
what are the clinical signs of abdominal wall dehiscence?
wound oedema or inflammation
serosanguinous drainage from the incision
painless swelling
what does intestinal dehiscence lead to? how long after surgery?
septic peritonitis
usually within 2-5 days post-op
what are the clinical signs of peritonitis?
depression anorexia vomiting abdominal pain acute collapse
what are the risk factors for dehiscence?
poor surgical technique (wound tension, suture choice)
self-trauma
underlying neoplasia of area
closure of non-viable skin
systemic factors (endocrine disease, obesity, cats viral status, hypoproteinaemia, hypovolaemia)
how can you help to prevent dehiscence?
bandaging to immobilise areas of excessive motion
elizabethan collar to prevent self-trauma
animals should be confined, may be exercise-restricted for 2 weeks
what is peritonitis?
inflammation of the peritoneum
what are the 2 types of peritonitis?
primary = only occurs in cats (FIP)
secondary = as a result of another pathology
what are the 2 types of secondary peritonitis?
aseptic = mild reaction to surgery, sterile object left indwelling septic = infectious
what are some of the reasons peritonitis might happen?
dehiscence
ischaemic necrosis
leakage during surgery
infection through technique
leaving something in patient
how does peritonitis present?
vague history of anorexia, vomiting, lethargy, pyrexia, acute collapse
may adopt prayer position
3-5 days post-op
what post-op complications can arise in the oesophagus?
regurgitation
oesophagitis (inflammation and ulceration)
strictures
what post-op complications can arise after gastric surgery?
vomiting anorexia ulceration gastric outlet obstruction (pylorus) pancreatitis
what complication is important to look out for after gastropexy for GDV?
ECG abnormalities due to reperfusion of gastric tissues once stomach is untwisted
what post-op complications can occur after SI surgery?
serosal and peritoneal adhesions (rough technique/excessive handling)
ileus
perforation
stenosis
intestinal strictures (rare)
diarrhoea, anorexia
what are the common small intestinal surgeries in first opinion practice?
enterotomy for foreign body
enterectomy following foreign body or intussusception
what are some possible complications after LI surgery?
haemorrhage and faecal contamination during surgery (most common)
leakage
stricture
stenosis
incontinence (rare)
what are the possible post-op complications after perineum/rectum/anus surgery?
tenesmus
rectal prolapse
temporary/permanent incontinence
anal stricture
urethral obstruction
stenosis
what is an anal sacculectomy?
removal of one/both of the anal sacs
what are the post-op complications for an anal sacculectomy?
may be due to nerve damage or muscle resection
seroma is common
2% may have permanent faecal incontinence or weak anal tone
what are the key signs to monitor for in the post-op period?
depression, pyrexia, anorexia, vomiting
abdominal tenderness
wound care
what are the main aims for the post-op care plan?
restore hydration and maintain electrolyte balance
resume normal feeding and gut motility
manage GI effects e.g. nausea
manage pain
prevent infection
after which surgeries are patients encouraged to eat as soon as able?
intestinal, rectal or anal
should patients eat ASAP after gastric/oesophageal surgeries?
no - water 2 hours post surgery, food 12 hours later (due to likelihood of vomiting)
what are the signs of nausea?
salivation, repeated swallowing, lip-licking
what drugs are available to help with nausea?
maropitant (anti-emetic, some abdominal pain relief)
metoclopramide (anti-emetic and prokinetic)
ranitidine, sucralfate, omeprazole (none licensed)
what other drugs might me useful post-GI surgery?
prokinetic agents to manage ileus
probiotics
appetite stimulants may be useful (esp. cats)
can NSAIDs be used for post-op pain relief?
caution as can cause ulceration and GI upset - considered on a case by case basis
can opioids be used for post-op pain relief?
almost always used
may affect gut motility so will have to assess when to wean off and move to alternative analgesia for discharge
what other options are there for managing post-op pain?
codeine - but can cause constipation
paracetamol - dogs only
tramadol - does not suit all animals
how can you manage infection risk during/after GI surgery?
antibiotics most likely given peri-operatively
may be discontinued 6-12 hours post-op unless contaminated surgery or systemic illness
