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Surgery (Spring 2015) > L16: Surgical Complications (Ellison) > Flashcards

L16: Surgical Complications (Ellison) Flashcards

1
Q

infection

A

proliferation of micro-organisms within wound

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2
Q

dehiscence

A

separation of wound

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3
Q

etiology of wound infection/dehiscence

A
  • inadequate aseptic technique
  • improper suturing technique
  • self mutilation
  • drugs and medical conditions: steroids, Cushings, chemotherapy, anemia
  • surgery time-hypothermia
  • anesthetic agents: propofol
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4
Q

types of wound dehiscence

A

Superficial separation: can be:
-uninfected (re-suture or staple)
-infected (hot soak, abx, may or may not require 2ary closure)
Herniation with Evisceration

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5
Q

abx selection for dehiscence

A
  • staphylococcus, strep: amoxicillin, clavamox, cephalosporins
  • E. coli proteus: baytril
  • Anaerobic bacteria: metronidazole
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6
Q

Incisional swelling

A
  • some swelling is normal in all wounds
  • differentiate b/w edema vs. seroma vs. hernia with palpation, FNA, ultrasound
  • if can push up into abdomen, most likely a hernia
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7
Q

seroma/hematoma

A
  • seroma: pocket of clear serous fluid that sometimes develops in the body after surgery
  • hematoma: blood “ “
  • tx: tap (often recurs), drains (may infect), usually resolve spontaneously
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8
Q

most important closure

A

SC closure

-if animal chews up skin sutures, prevents evisceration. If deeper sutures break, prevents hernia

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9
Q

incisional hernia

A
  • herniation with skin intact

- tx: elective sx, may have to resect herneal sac

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10
Q

Tx of herniation with evisceration wound dehiscence

A
  • emergency sx

- may have to resect and anastomose

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11
Q

iatrogenic burns

A

clipper burns

thermal burns

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12
Q

peritonitis

A

inflamm. of the abd. cavity
-can be:
localized (ie. sponge left in)
generalized (ie. uroabdomen/uroperitoneum)
chemical (ie. tear in bile duct w/ powerful inflamm. response)
septic (ie. leaking anastomosis)
combined

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13
Q

examples of chemical peritonitis

A 
pancreatitis
bile leakage
trauma
urine leakage
gastric perforation
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14
Q

ex. of septic peritonitis

A

surgical contamination
sharp trauma
extension of reproductive or urinary tract infection
bowel perforation

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15
Q

ex. of localized peritonitis

A
  • local vasodilation + pain
  • extravasation of plasma
  • neutrophil migration
  • platelet aggregation
  • fibrin clots
  • fibrous adhesions
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16
Q

ex. of generalized peritonitis

A
  • fluid + protein shifts
  • hemoconcentration + ____
  • hypovolemic shock
17
Q

consequences of bacteria + endotoxins

A
  • neuts to abdomen
  • hypoglycemia
  • metabolic acidosis
  • septic shock
18
Q

dx of peritonitis

A
  • PE, Rads, BW

- U/S (including abdominocentesis, diagnostic peritoneal lavage (DPL))

19
Q

what does peritonitis look like on rad

A
  • generalized abdominal hazinees
  • loss of visceral detail
  • free abdominal air*
  • ileus
20
Q

Fluid sample processing

A
  • cytology
  • assess glucose, creatinine, and lactate vs. serum lvls
  • if creatinine > serum –> urine leakage
  • if amylase > 1000 = pancreatic inflammation
21
Q

tx of peritonitis

A

-medical management of hypovolemic or septic shock
-tx of infection/sepsis
-correction of the underlying cause
-providing peritoneal drainage when necessary
“dilution is a solution of pollution”

22
Q

abx therapy of peritonitis

A
  • E. coli, Proteus sp., Staph aureus, Enterococcus, Bacteroides
  • Cefoxitin, Cefazolin, Baytil, Metronidazole (gram negs), imipenum
23
Q

surgical management of peritonitis

A
  • STOP THE CONTAMINATION
  • close perforations, resection and anastamosis
  • omental wrap, serosal patch, jejunal onlay graft
24
Q

Serosal patching indications

A
  • intestinal perforations
  • gastric ulcer
  • FB
  • gun shot wound
  • buttress any hollow
  • organ sx - bladder, uterus, diaphragm
25
Q

Serosal patching: technique

A
  • usually use jejunum
  • no tension or twist
  • suture 3-4mm beyond margins
  • 3-0 polypropylene
  • mucosa migrates over defect
26
Q

peritoneal drains

A
  • silicone or latex
  • sealed by fibrin and omentum in 6hrs
  • don’t “drain” peritoneal cavity
  • effective for localized peritonitis
27
Q

drain effectiveness

A

gauze: 20%
penrose: 30%
penrose sump: 50-60%
triple lumen sump: 70%
triple lumen + suction: 80%
(drains don’t work very well unless they have active drainage)

28
Q

intermittent peritoneal lavage (S.O.!)

A
  • Ingress-Egress system
  • Peritoneal dialysis catheter
  • 20ml/kg LRS, 0.9 NaCl, BID
  • hypoproteinemia, hypokalemia
29
Q

Open peritoneal drainage - indications

A
  • generalized septic peritonitis
  • anaerobic bacteria
  • blood components
  • good support staff
30
Q

Open peritoneal drainage

A
  • gap linea alba 1-2cm
  • skin + SC antibiotic ointment
  • non-adherent bandage
  • sterile cotton roll
  • changed 12-24hr intervals
  • wound closed in 1-5d
31
Q

complications of open peritoneal drainage

A
  • dehydration
  • hypoproteinemia
  • high mortality
32
Q

controversial therapes

A
  • intraperitoneal povidone iodine
  • intraperitoneal antibiotics
  • intraperitoneal heparin
  • peritoneal drainage
33
Q

intraperitoneal abx:

A
  • don’t excedd parenteral levels
  • don’t increase survival
  • may be indicated for prophylaxis

Surgery (Spring 2015) (21 decks)

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