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304: GI > Post-op complications > Flashcards

Post-op complications Flashcards

1
Q

Early rest complications

A

Commonly
- Underlying lung disease

Pneumothorax
- Positive pressure ventilation

ARDS
- Usually sick previously

Opiate overdose- respiratory depression
- Resp depression, pin point pupils, coma.

Atelectasis

  • Alveolar collapse due to secretions sit
  • Poor ventilation

Infection

Embolism

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2
Q

Early complications

- Bleeding

A

Primary
- At surgery

Reactionary
- Few hours after surgery

Secondary
- 5-10 days post surgery

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3
Q

Grades of hypovolaemic shock

A

1- <15% blood loss
- Resp rate is the most sensitive (14-20)

2- 15-30%

  • RR= 20-30
  • Increased DBP
  • Urine output= 20-30mL

3- 30-40%

  • Urine output 5-15
  • BP drops
  • RR= 30-40
  • Tachycardia

4- >40%
- Anuria

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4
Q

SIRS

- 4 features

A

Tachycardia
- >90

Tachypnoea
- >20

Temperature
- >38, <36

WCC
- >12, <4

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5
Q

Sites of sepsis

A

Lines

  • Cannulae, change every 72 hrs
  • Central lines, change every 7 days

Urinary

Wound

Chest

Abdomen/pelvis

C. difficile
- Antibiotics.

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6
Q

Risk factors for wound infection

A

Cardio/ resp

  • Age
  • Resp disease
  • Smoking
  • DM
  • Obesity

Organ failure

Steroids

Local factors

  • Faecal peritonitis
  • Emergency
  • Irradiation
  • Lower midline incision= more stretch

Malignancy

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7
Q

Wound infection management

A

Swab- culture

Mark extent of cellulitis

Blood tests

  • Inflammatory markers
  • Culture

Appropriate antibiotics

Drain abscess/ stoma bag

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8
Q

Risk factors for DVT

  • Stasis
  • Endothelial trauma
  • Hypercoaguability
A

Stasis

  • Long operation
  • Ortho surgery
  • Pregnancy
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9
Q

DVT prophylaxis

A

Thromboembolic stockings

Intraoperative compression
- compresses veins by inflating and deflating

LMW hep/ Unfractionated hep (kidney failure)

Early mobilisation

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10
Q

Late complications

A

Incisional hernia

Operation specific
- I.e stoma retraction

Recurrence of cancer

Adhesions

Keloid scarring/ hypertrophic scars

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11
Q

UTI post op management

A

ABCDE

Sepsis 6

Local antibiotic guideline

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12
Q

Transfusion reaction

  • Signs and symptoms
  • Management
A

Mild
- Hives and itching

Fevers/chills

Hypotension

Dyspnea
- Volume overload

Management

  • Stop transfusion
  • ABCDE
  • IV steriods/ adrenaline
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13
Q

Post-op tachycardia causes

A

Pain

Infection

Bleeding

Reaction: drug, transfusion

Compartment syndrome

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14
Q

Reduced urine output post-op causes

A

Dehydration/ inadequate fluid input/ fluid loss

Catheter blocked

Urinary retention

SIADH

Contrast reaction

Ureter damage

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15
Q

Late-complications (Day 4-30)

A

Infection

  • Wound/ skin
  • Chest
  • Urinary
  • Abdomen
  • Head

Anastomosis leak (especially day 3/4)

DVT/ PE

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16
Q

DVT risk factors

A

Previous DVT

17
Q

Post-op ileus

  • description
  • symptoms
  • Treatment
A

Physiological response to abdominal surgery

  • Lack of peristalsis, normal a few days after surgery.
  • > 4 days= prolonged ileus

Symptoms

  • Nausea, vomiting
  • Bowel distention
  • Abdo pain

Treatment

  • IV fluid
  • good fluid balance
  • Consider NG tube if they are vomiting
  • Nutritional support may occur
18
Q

Anastomotic leak

  • Description
  • Signs and symptoms
  • Management
A

Usually occurs 3-4 days post-op

Lack of perfusion to anastomosis can cause it to breakdown and leak bowel contents into the abdomen.

Signs and symptoms

  • Worsening abdominal pain
  • Vomiting
  • Failure to progress
  • Tachycardic, temperature, febrile, tachypnoea.

Management

  • Warm saline to wash out the abdominal and pelvic cavity.
  • Complication: collection can form after washing out
19
Q

Bile leak

  • Description
  • Presentation
  • Management
A

Cholecystectomy complication

  • Usually when common bile duct is being mobilised to reach the gallbladder and causes damage to biliary tree
  • 2-10 days post-op

Presentation

  • Abdominal pain
  • Fever
  • CRP may be raise

Management

  • ABCDE
  • antibiotics
  • Drainage and specialist repair (stent or surgical repair)
20
Q

Wound complications

A

Dihescence
- Tension/ pressure in wound

Haematoma

Skin infection

Stitch abscess
- Occurs when suture is too close to the skin so infection pockets into skin

Seroma
- Post-op collection of interstitial fluid due to soft reaction

21
Q

Delayed complications (30 days+)

  • Hernia
  • Bowel resection
  • Splenectomy
  • Scar
  • Transplant
A

dymr

304: GI (20 decks)

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