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Year 3 perioperative management > Post op complications > Flashcards

Post op complications Flashcards

1
Q

Immediate surgical complications

A
  • Intubation → oropharyngeal trauma
  • Surgical trauma to local structures
  • Primary or reactive haemorrhage
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2
Q

Early surgical complications (1 day to 1 month)

A
  • Secondary haemorrhage
  • VTE
  • Urinary retention
  • Atelectasis and pneumonia
  • Wound infection and dehiscence
  • Antibiotic-associated colitis (AAC)
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3
Q

Late surgical complication (after 1 month)

A
  • Scarring
  • Neuropathy
  • Failure or recurrence
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4
Q

Complications of cholecystectomy

A
  • Conversion to an open procedure
  • Common bile duct injury
  • Bile leak
  • Retained stones (needing ERCP)
  • Fat intolerance / loose stools
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5
Q

Complications of Inguinal Hernia Repair

A 
Early: 
• Haematoma/ seroma formation
• Intra-abdominal injury 
• Infection
• Urinary retention

Late:

  • Recurrence
  • Ischaemic orchitis
  • Chronic groin pain or paraesthesia
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6
Q

Appendicectomy complications

A

• Abscess formation
• Fallopian tube trauma
• Right hemicolectomy (e.g. for carcinoid, caecal
necrosis)

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7
Q

Colonic Surgery complications

A 
Early:
- Ileus
-  Anastomotic leak
- Enterocutaneous fistulae
-  Abdominal or pelvic abscess
Late:
- Adhesions causing obstruction 
- Incisional hernia
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8
Q

Post-op Ileus causes, presentation and tx

A

Causes:

  • Bowel handling
  • Anaesthesia
  • Electrolyte imbalance

Presentation:

  • Distension
  • Constipation ± vomiting
  • Absent bowel sounds

Tx:

  • IV fluids + NGT
  • TPN if prolonged
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9
Q

Anorectal Surgery complication

A
  • Anal incontinence
  • Stenosis
  • Anal fissure
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10
Q

Small Bowel Surgery complications

A

• Short gut syndrome

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11
Q

Splenectomy complications

A

• Gastric dilatation secondary to gastric ileus
- Prevented with NGT
• Thrombocytosis → VTE
• Infection by encapsulated organisms

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12
Q

Arterial Surgery complications

A
  • Thrombosis and embolisation
  • Anastomotic leak
  • Graft infection
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13
Q

Aortic surgery complications

A
  • Gut ischaemia
  • Renal failure
  • Aorto-enteric fistula
  • Anterior spinal syndrome (paraplegia)
  • Emboli → distal ischaemia
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14
Q

Breast surgery complications

A
  • Arm lymphoedema
  • Skin necrosis
  • Seroma
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15
Q

Urological surgery complications

A
  • Sepsis

* Uroma: leakage of urine

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16
Q

Prostatectomy complications

A
  • Urinary incontinence
  • Erectile dysfunction
  • Retrograde ejaculation
  • Prostatitis
17
Q

Fracture Repair complications

A
  • Mal-/non-union
  • Osteomyelitis
  • Avascular necrosis
  • Compartment syndrome
18
Q

Hip Replacement complications

A
  • Deep infection
  • VTE
  • Dislocation
  • Nerve injury: sciatic, SGN
  • Leg length discrepancy
19
Q

Causes of post op pyrexia

A

Early: 0-5d post-op
• Blood transfusion
• Physiological: sepsis secondary to trauma
• Pulmonary atelectasis
• Infection: UTI, superficial thrombophlebitis, cellulitis
• Drug reaction

Delayed: >5d post-op
• Pneumonia
• VTE
• Wound infection
• Anastomotic leak
• Collection
20
Q

Causes of pneumonia post op

A
  • Anaesthesia causing atelectasis
  • Pain causing decreased cough
  • Surgery - immunosuppression
21
Q

Presentation of collection

A
  • Malaise
  • Swinging fever, rigors
  • Localised peritonitis
  • Shoulder tip pain (if subphrenic)
22
Q

Investigations of collection

A
  • Bloods - FBC, CRP, cultures
  • US, CT
  • Diagnostic lap
23
Q

Tx of collection

A
  • Abx

* Drainage / washout

24
Q

Causes of post op hypotension (CHOD)

A

• Cardiogenic

  • MI
  • Fluid overload

• Hypovolaemia

  • Inadequate fluid replacement
  • Haemorrhage

• Obstructive
- PE

• Distributive

  • Sepsis
  • Neurogenic shock
25
Q

Mx of post op hypotension

A

Immediate:

  • tilt bed so head is down
  • give O2
  • assess fluids

Mx:
• Hypovolaemia → fluid challenge - 500ml colloid over 15min
• Haemorrhage → return to theatre
• Sepsis → fluid challenge, and start Abx
• Overload → furosemide
• Neurogenic → saline infusion

26
Q

Opioid overdose

A

Presentation:

  • decreased RR
  • hypotension
  • decreased saturation
  • confused
  • decreased GCS

Mx:
- 400mcg naloxone IV

27
Q

Transfusion related acute lung injury

A

After given blood transfusion

  • ARDS : Drop in O2 Sats, abnormal CXR, SOB, Hypotensive
  • senior input and ITU
28
Q

Reduced urine output cause and Mx

A

Post renal AKI - catheter

Urinary retention - USS bladder

UTI - urine dip

Pre renal AKI e.g. due to dehydration - 1L 0.9% Hartmann’s solution over 8 hrs

29
Q

Gastric dumping syndrome presentation

A
  • after gastric bypass
  • profuse vomiting
  • sweaty
  • tingling lips
  • dizzy
  • tachycardia and tachypnoea
30
Q

Mx of gastric dumping syndrome

A

1L 10% dextrose over 8 hrs

31
Q

Gastric dumping syndrome

A

Dinner dumped in small intestine as smaller stomach

Fluid shift causing N+V

Surge of insulin release causes hypoglycaemia

Year 3 perioperative management (23 decks)

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