Post op complications Flashcards
How would you classify post op complications
Local: involving the operation itself
General: affecting the systems of the body
or
Immediate: within 24hrs
Early: within 4 weeks
Late: after 4 weeksHow is post op haemorrhage classified?
Primary: immediately
Secondary: reactionary (24hrs, subsequent to infection, typically around day 10.
What are the main causes of hypotension post op
Bleeding:
ruptured clot
misplaced sutures
ischemic bowel
wound
drain site
Cardiac insult:
MI
Pulmonary insult:
PE
Infectious insult:
sepsis
Neurological insult:
epidural anaesthetic
What are the causes of PE?
Trauma Obesity Malignancy Surgery Cardiac disease Hospilaisation Rest Elderly Past hx Fracture Oestrogen Long flights
What are the causes of hypertension post op?
Pain
Inadequate analgesia
Urinary retention
Anxiety
What are the causes of post op pyrexia?
Catheter Cannula/ central line Cut (wound infections) Cellulitis Chest (atelectasis or PE) Calf (DVT) Collection
< 24hrs post op: systemic response to surgery
Day 1- 3: atelectasis, pneuomonia
Days 4- 7: wound infection, UTI, intra-abdominal sepsis, anastomotic dehiscence
Day 7- 10: DVT, PE
What are the causes of post op confusion?
DELIRIUM
Drugs
Electrolyte imbalance
Lack of drugs (alcohol/ heroin withdrawal)
Infection
Reduced sensory input (new surroundings, blindness)
Intracranial problems - TIA, stroke, post ictal
Urinary retention
Myocardial problems
Which patients are at risk of post op renal failure?
Liver diseases especially obstructive jaundice
Obstructive nephropathy (post renal failure secondary to retention)
Renal vascular disease
Drugs (NSAIDs, ACE inhibitor)
What factors increase the risk of wound infection?
Haematoma, poor nutritional state, diabetes mellitus, reduced immunity, nasal carriage of staph aureus.
What factors delay wound healing and therefore increase the chance of wound breakdown?
Old age, obesity, malnutrition, poor vascularity, sepsis, carcinoma, jaundice, uraemia, steroids, haematomas, raised intra abdominal pressure.
Describe a burst abdomen
The sudden bursting of a wound revealing bowel.
Often preceeded by a discharge of salmon pink fluid.
Cause is usually inadequate suturing of the abdominal wall.
Mortality of 20%
What is the incidence of an incisional hernia?
10%. Factors include: poor wound healing, poor suture technique, raised intro abdominal pressure (paralytic ileus), coughing, straining, prostatism.
Often they are wide necked and do not cause a problem.
What are the causes of anastomotic breakdown?
Poor surgical technique, ischemia at the anastomosis, perioperative sepsis, distal obstruction, residual inflammatory disease (crohns or malignancy), general condition (uraemia, jaundice, malnutrition, steroids)
Is a major cause of post op mortality and morbidity after surgery.
May result in generalised peritonitis, paracolic abscess, or fistula formation, but also may present insidiously with a mild fever, tachycardia, and general failure to progress.
What investigations need to be carried out if a patient is confused post operatively?
HB, FBC, U&Es, glucose, amylase, ABG, blood culture, urine analysis, sputum culture, CXR, brain scan.
Describe a paralytic ileus
Cessation of GI motility, atony is expected for 24 - 48 hrs post op but when it continues after 48 hours a cause must be ruled out.
Causes: fractures of the spine and pelvis, retroperitoneal haemorrhage, peritonitis, hypokalaemia, drugs, abdominal surgery, immobilization.
BS = absent AXR = gaseous distension throughout the small and large bowel
Treat with NG tube and IV fluids, treat any electrolyte imbalance
