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CVNT2 > GI surgery - post-op care > Flashcards

GI surgery - post-op care Flashcards

1
Q

what nutritional considerations should be made after GI surgery?

A

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

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2
Q

what wound considerations should be made post GI surgery?

A

ensure wound is appropriately dressed or covered, dry and frequently checked

ensure animal is positioned appropriately to minimise pressure on wound

prevent interference

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3
Q

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

A

physiological abnormalities worsening (hypothermia, hypovolaemia etc)

pain

haemorrhage

drug or anaesthetic reaction

vomiting/regurgitation

trauma or increase in abdominal pressure causing acute wound breakdown

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4
Q

what are the possible longer term post-op complications (days)?

A 
pain 
haemorrhage 
aspiration pneumonia 
ileus
infection of wound, interference
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5
Q

what is dehiscence?

A

the disruption of wounds edges - can refer to an organ or tissue

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6
Q

when is dehiscence usually seen?

A

most commonly seen at 3-5 days post-op - end of lag phase of healing

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7
Q

where are the 3 likely areas of dehiscence after GI surgery?

A

skin
abdominal wall
intestines

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8
Q

when does skin/cutaneous dehiscence usually happen?

A

4-5 days post-op

could be seen immediately if trauma occurs

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9
Q

what are the clinical signs of skin/cutaneous dehiscence?

A

serosanguinous or purulent discharge from suture line

swelling and bruising or necrosis of edges

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10
Q

what is abdominal wall dehiscence?

A

dehiscence of the abdominal muscles underneath a wound - creates a hernia

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11
Q

when does abdominal wall dehiscence typically occur?

A

usually within first 7 days (but can be weeks or years after surgery)

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12
Q

what are the clinical signs of abdominal wall dehiscence?

A

wound oedema or inflammation
serosanguinous drainage from the incision
painless swelling

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13
Q

what does intestinal dehiscence lead to? how long after surgery?

A

septic peritonitis

usually within 2-5 days post-op

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14
Q

what are the clinical signs of peritonitis?

A 
depression 
anorexia 
vomiting 
abdominal pain 
acute collapse
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15
Q

what are the risk factors for dehiscence?

A

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)

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16
Q

how can you help to prevent dehiscence?

A

bandaging to immobilise areas of excessive motion

elizabethan collar to prevent self-trauma

animals should be confined, may be exercise-restricted for 2 weeks

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17
Q

what is peritonitis?

A

inflammation of the peritoneum

18
Q

what are the 2 types of peritonitis?

A

primary = only occurs in cats (FIP)

secondary = as a result of another pathology

19
Q

what are the 2 types of secondary peritonitis?

A 
aseptic = mild reaction to surgery, sterile object left indwelling 
septic = infectious
20
Q

what are some of the reasons peritonitis might happen?

A

dehiscence

ischaemic necrosis

leakage during surgery

infection through technique

leaving something in patient

21
Q

how does peritonitis present?

A

vague history of anorexia, vomiting, lethargy, pyrexia, acute collapse
may adopt prayer position
3-5 days post-op

22
Q

what post-op complications can arise in the oesophagus?

A

regurgitation
oesophagitis (inflammation and ulceration)
strictures

23
Q

what post-op complications can arise after gastric surgery?

A 
vomiting 
anorexia 
ulceration 
gastric outlet obstruction (pylorus) 
pancreatitis
24
Q

what complication is important to look out for after gastropexy for GDV?

A

ECG abnormalities due to reperfusion of gastric tissues once stomach is untwisted

25
Q

what post-op complications can occur after SI surgery?

A

serosal and peritoneal adhesions (rough technique/excessive handling)

ileus

perforation

stenosis

intestinal strictures (rare)

diarrhoea, anorexia

26
Q

what are the common small intestinal surgeries in first opinion practice?

A

enterotomy for foreign body

enterectomy following foreign body or intussusception

27
Q

what are some possible complications after LI surgery?

A

haemorrhage and faecal contamination during surgery (most common)

leakage

stricture

stenosis

incontinence (rare)

28
Q

what are the possible post-op complications after perineum/rectum/anus surgery?

A

tenesmus

rectal prolapse

temporary/permanent incontinence

anal stricture

urethral obstruction

stenosis

29
Q

what is an anal sacculectomy?

A

removal of one/both of the anal sacs

30
Q

what are the post-op complications for an anal sacculectomy?

A

may be due to nerve damage or muscle resection
seroma is common
2% may have permanent faecal incontinence or weak anal tone

31
Q

what are the key signs to monitor for in the post-op period?

A

depression, pyrexia, anorexia, vomiting

abdominal tenderness

wound care

32
Q

what are the main aims for the post-op care plan?

A

restore hydration and maintain electrolyte balance

resume normal feeding and gut motility

manage GI effects e.g. nausea

manage pain

prevent infection

33
Q

after which surgeries are patients encouraged to eat as soon as able?

A

intestinal, rectal or anal

34
Q

should patients eat ASAP after gastric/oesophageal surgeries?

A

no - water 2 hours post surgery, food 12 hours later (due to likelihood of vomiting)

35
Q

what are the signs of nausea?

A

salivation, repeated swallowing, lip-licking

36
Q

what drugs are available to help with nausea?

A

maropitant (anti-emetic, some abdominal pain relief)
metoclopramide (anti-emetic and prokinetic)
ranitidine, sucralfate, omeprazole (none licensed)

37
Q

what other drugs might me useful post-GI surgery?

A

prokinetic agents to manage ileus
probiotics
appetite stimulants may be useful (esp. cats)

38
Q

can NSAIDs be used for post-op pain relief?

A

caution as can cause ulceration and GI upset - considered on a case by case basis

39
Q

can opioids be used for post-op pain relief?

A

almost always used

may affect gut motility so will have to assess when to wean off and move to alternative analgesia for discharge

40
Q

what other options are there for managing post-op pain?

A

codeine - but can cause constipation

paracetamol - dogs only

tramadol - does not suit all animals

41
Q

how can you manage infection risk during/after GI surgery?

A

antibiotics most likely given peri-operatively

may be discontinued 6-12 hours post-op unless contaminated surgery or systemic illness

CVNT2 (47 decks)

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