Post-Op Complications of Abdominal Sx Flashcards
you should check _____ daily for evidence of: (4)
twice daily:
- swelling
- pain
- redness
- discharge or dehiscence
what does dehiscence mean
breakdown
when do we remove skin sutures
10-14d
what are 6 examples of incisional complications
1) inflammation
2) infection
3) hematoma
4) seromas
5) evisceration
6) herniation
how does evisceration differ from herniation
evisceration: organs coming completely out of the body
herniation: organs out of abdominal cavity but contained within skin
T/F post-op inflammation always indicates infection
F
at what point post-op do we assume the inflammation has progressed to infection
a couple of days have passed and you still see lots of inflammation
with post-op inflammation, when should you apply a cold pack and when should you apply a warm pack
cold: first few days
warm: seroma
what can we do to help patients with hemorrhage or hematoma post-op
pressure bandage/resorption
if marked hemorrhage, what follow-up should we be doing
monitoring PCV
scrotal hematomas are typically caused by poorly ligated ____________ vessels, NOT _________ vessels
tunic; testicular (they would cause hemoabdomen)
T/F you should apply a cold pack to a hematoma
F; warm pack
what is the concern with hematomas
they are a great medium for bacterial growth and can become infected
when do we most often see seromas (what timeline)
delayed (>5 days)
how do seromas typically present
fluctuant swelling that is non-painful and tends to be gravity dependent
how do we confirm seromas vs hematomas
on ultrasound will appear serosanguinous; aspiration will show pale yellow-red fluid
how do we treat seromas
- drain as much as possible and bandage
- warm pack
- can drain or close dead space if recurrence
what do you do in the case of tension and breakdown/dehiscence/skin necrosis
remove dead tissue, clean, bandage and let heal by second intention
what is a location that is prone to infection after surgery and why
toes/paws; moist, hard to prep, non-sterile location
with what post-op complication do we typically need to intervene
infection and breakdown
how do we fix infected wounds/breakdown of wounds from best case to worst case
- clean, examine, +/- bandage
- remove sutures, lavage, let heal by second intention
- surgical debridement, lavage +/- closure
what are two considerations with all infected wounds
whether to culture and whether to give antibiotics
what is the definition of evisceration
herniation of peritoneal content through the body wall with exposure of the abdominal viscera
what is the first sign of evisceration
swelling and serosanguinous discharge
what are the 4 most common causes of evisceration
1) poor integration of the external rectus fascia in each suture bite
2) suture breakage
3) knot slippage or untying
4) suture cutting through tissues
what is the most common comorbidity associated with dehiscence
infected wound
along what timeline do we typically see evisceration and dehiscence
within first 5-7 days
what typically eviscerates
omentum and intestines
what are the 2 most common causes of evisceration
poor apposition of suture layers or poor suture technique
what are three complications of evisceration
- serious self-mutilation
- hemorrhage
- shock
T/F most evisceration occurs in cat spays due to the fact that this surgery specifically predisposes to infection and breakdown
F: most common in spays but due to how often the procedure is performed rather than a complication
T/F evisceration is commonly contaminated with dirt, leaves, litter
T
how do we treat/correct evisceration
- cover with saline sterile towels and lightly bandage
- stabilize patient
- antibiotics
- anesthetize asap: lavage, resect, lavage, close
T/F survival is very high after evisceration post-OHE
T
when do we typically see herniation
10-21 days post-op (whereas evisceration is within the first 5-6 days)
what causes herniation
when the linea breaks down after skin healing has occurred
what is the risk with herniation
organ entrapment and ischemia
often the actual linea site is what size
small; < 1cm
in what case do we see a small hernia that grows with time
if it includes fat, which then grows externally as the patient gains weight
what are the two types of peritonitis
chemical and septic
how do we treat peritonitis
- treat problem
- lavage
- leave drains
what is the most common item lost in surgery (inside the patient!)
sponges (then needles, then instruments)
what are 3 ways to ensure you do not leave anything inside the patient
- counting sponges in and out
- radioopaque gauze
- having a surgical checklist
