post op complications

Question 1

VTE prophylaxis

Answer 1

1. elective hip -
   - LMWH and stockings for 28 days
   - Rivoraxaban
2. Elective knee - anticoag for 14 days
3. fragility fractures for 1 month
4. START VTE prophylaxis 6 hours post op

Question 2

post op pyrexia (within 1 day)

Answer 2

physiological systemic inflammatory reaction

Question 3

post op pyrexia (0-5 days)

Answer 3

1. uti
2. cellulitis
3. pulmonary atelectasis

Question 4

post op comp pyrexia > 5 days

Answer 4

1. VTE
2. pneumonia
3. anastomotic leak
4. wound infection

Question 5

urinary retetion

Answer 5

RF - constipation (opiod?) / removal of urinary catheter/ infection

2. Presents few hours after catheter is removed

Question 6

post op pyrexia

Answer 6

day 1-2 > consider resp cause
day 3-4 > urinary tract cause
day 5 -7 > surgical site infection/absncesss

Mx - Septic screen and start Abx

Question 7

asatomotic leak

Answer 7

1. cause new onset AF following GI surgery
2. generalised sepsis causing perionitis and abdo rigidity / pyrexial / tachycardic
3. CT scan
4. Mx - surgery

Question 8

post op ileus

Answer 8

deceleration or arrest of intestinal motility following surgery - functional bowel obstruction

CF - abdo distention/bowel sounds/failure to pass faeces/N+V

FBC - fluid and electrolytes loss

Mx - nasogastric tube and replacement of electorlytes

Question 9

post op poor pain mx

Answer 9

after abdo surgery - inadequate ventilation and subsequent atelectasis and hospital acquired pneumonia

Question 10

causes of post op nausea and vomiting

Answer 10

1. opiate analgesia
2. inhalant agens - NO/Isoflurane
3. infection
4. post op ileus and bowel obstruction
5. hypercalcaemia/uraemia.DKA

Question 11

Mx of Post op Na nd V

Answer 11

1. dexamethasone at induction of anaesthesia
2. impaired gastric emptying/metabolic or biochemical derangement - metocopromide
3. bowel obstruction - Hyoscine to reduce secretions
4. opiod induced nausea and vomiting - odanestron