Post-operation complications (Surgery) Flashcards
What are some of the local complications post surgery?
1?
2?
3?
4?
5?
6?
7?
8?
1. Haemorrhage
2. Wound dehiscence
- Wound infection
- Scar formation
- Neuropraxia
- Delayed/non/mal-union
7. Return of original deformity
8. Iatrogenic deformity
What factors could result in Haemorrhage?
Poor 1?
Poor 2?
Ambulate patient 3?
4? therapy/thrombocytopaenia
Result
5?
6?
7?
- haemostasis
- suturing technique
- too early
- Anticoagulant
Result
- Wound dehiscence
- Infection
- Scaring
Keloid scars
1? tumors
Composed mainly of an 2?
More common in 3?
Tx – 4?
- Fibrotic
- Overgrowth of either type III (early) or type I (late) collagen
- Younger individuals and in highly pigmented individuals
- Prevention, laser therapy
Hypertrophic scar formation
definition 1?
Poor 2?
• Excessive use of 3?
Wound dehiscence
Infection
•Poor scar management
post-suture removal
- Raised scars that do not grow beyond the boundaries of the original wound
- suturing technique
- electrocautery
What are some signs of infection post-operatively?
Abnormal 1?
2?
Wound 3?
4?
- post-op pain after 2-5 days
- Dolor, oedema & erythema
- dehiscence/discharge
- Cellulitis - local extension of inflammation
How do you manage local infection?
Drainage of 1?
removal of 2?
Irrigation and wound dressing
MCS +/- FBC
- wound
- some or all sutures
What are the choices of antibiotics for local infections?
1?
(delayed allergy to penicillin) 2?
(immediate allergy to penicillin) 3?
- Oral di/flucloxacillin 500 mg qid
- Oral cephalexin 500 mg qid
- Oral clindamycin 450mg tid
What are some complications following matrixecotomies?
1?
2?
3?
- Hypergranulation tissue
- Infection
- Phenolburn
What are the general complications post surgery?
- Extension of local infection
- Pulmonary
3. Cardiovascular
4. Neurological
5. Gastroenterological
6. Gynaecological
Lymphangitis 1?
Lymphadenopathy 2?
Fever/chills
Management 3?
- Superficial erythematous streaking to popliteal or inguinal glands
- inflammation/ tenderness of inguinal lymph glands
- Patient needs hospitalisation, ID consult and IV antibiotics
What do pts with COPD have?
1?
2?
3?
- Asthma
- Emphysema
- Chronic bronitis
Atelectasis:
Collapse of the lung
Clinical presentation:
1?
2?
3?
4?
5?
- +/- Elevated temp
- Cough
- Chest pain
- Increased respiratory rate
- Low O2 saturation
What are the treatment options for Atelectasis?
- Deep breathing/spirometry
- Fizziotherapy
- Antibiotics
Atelectasis:
1? collapse
Decreased perfusion ⇒ 2?
Usually apparent 3?
Dx – x-ray – affected lobe is 4?
- Pulmonary
- absorption alveolar gas ⇒collapse with accumulation of secretions and mucous
- post-op day 2
- opaque
Pneumonia
Post-op chest
Characteristics 1?
2? of all operations
Predisposing factors 3?
Investigations 4?
Treatment 5?
- Segmental atelectasis, hypoxaemia, elevated temp, purulent sputum
- 5%
- age, smoking, obesity, preexisting lung disease
- chest x-ray, MC&S
- fizziotherapy, antibiotics
What does the red arros show?
Unhealthy, white = congestion
Pulmonary Embolism
Blockage of 1? , usually originating as 2?
Up to 10% 3?
10% pts die 4?
- pulmonary artery by embolis
- DVT in pelvis or legs (90%)
- post-op hospital deaths
- within 1 hr with up to 20% dying subsequently
What are the sign/symptoms of pulmonary embolism?
- Sudden pleuritic pain
- tachypnoea
- haemoptysis,
- fever, anxiety, wheeze, cough.
What are the treatment options for pulmonary embolism?
1?
2?
3?
- Medical emergency
- Fibrinolytic drugs
- Embolectomy
Deep vein thrombosis:
Present in 1? hospital deaths at autopsy
0.4% after childbirth
12-15% soft tissue injury to lower limbs
50% elderly after fracture femur/pelvis
2? all foot and ankle cases
- 25%
- 0.25%
DVT
Common after 1? operations
Possible outcomes:
2?
3?
4?
- lower abdominal, pelvic and lower extremity
- Fibrosis of clot with formation of collateral circulation
- Pulmonary emboli
- Post DVT syndrome
What is the Virchow’s triad for DVT?
1?
2?
3?
- Hypercoagulation
- Damage to vessel wall
- Venous stasis
What are the minor risk factors for DVT/PE?
1?
2?
3?
4?
5?
6?
- Immobility/bed rest
- Increasing age
- Minor surgery
4. Obesity
5. Varicose veins
6. Smoking
What are moderate risk factors for VTE?
1?
2?
3?
4?
5?
6?
7?
1. Malignancy
2. Heart or respiratory failure
- Oestrogens (HRT or OCP)
- Previous DVT/PE
5. Most non-major surgery
6. Thrombophilia
7. Postpartum period
What are major risk factors for VTE?
1?
2?
3?
4?
- Major fractures (especially hip)
- Hip or knee joint replacement
3. Other major surgery/trauma
4. Spinal cord injury
What’s the management option for DVT prophylaxis?
Mechanical methods:
1?
reduce risk of DVT by 2?
3?
Pharmacological methods: 4?
- Graduated compression stockings
- ~50%
- Intermittent pneumatic compression devices
- Unfractionated heparin (UFH) and Low Molecular Weight Heparin (LMWH) both highly effective/ Aspirin: small but significant reduction in risk (375mg/day)
Heparin use:
For all high risk cases: 1?
Consider for moderate & lower risk cases as
well
- LMW heparin
enoxaparin (Clexane) 20-40mg daily, or
daltepain (Fragmin) 2,500-5,000 units daily, or
Unfractionated heparin 5,000 units bd
- The difference between Low molecular weight heparin and unfractioned Heparin?
- Advantage of LMWH?
3. Advantage of UFH?
- Little difference in terms of efficacy (DVT prevention) or safety (risk of bleeding)
- Better dose-response relationship /More convenient (once daily)/ Less thrombocytopaenia/ Cost effective
- Short acting and can be reversed with protamine
What are the contraindications to anticoagulant prophylaxis?
1?
2?
3?
4?
5?
- Active bleeding
- History of GI bleeding
- High risk of bleeding (eg low platelet count)
- Severe hepatic disease
- Adverse reaction to heparin
What’s the contraindications to mechanical prophylaxis?
1?
2?
3?
4?
- Severe peripheral arterial disease
- Recent skin graft
- Severe peripheral neuropathy
- Severe leg deformity
Podiatric Surgical management:
Aim to keep patient 1?
Austin better than 2?
Caution with 3?
Compressive bandaging rather than 4?
- ambulating
- CBWO
- extended use of K-wires
- B-K casts
What is Pseudo-membranous enterocolitis?
Uncommon fulminating bowel infection due to emergence of resistant strains of 1?
Sings and Symptoms 2?
Treatment 3?
- Staphlococcus or Clostridium difficile
- Severe diarrheoa/ Abdominal distention/ Hypotension/ Shock
- Avoid prolonged antibiotic use Especially di/flucloxacillin/ Fluid replacement/ Vancomycin or metranidazole
