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General Surgery > Post operative complications > Flashcards

Post operative complications Flashcards

1
Q

What are some post op complications that can occur with regard to anaesthesia?

A
  • Painful throat from airway related trauma
  • Malignant hyperthermia
  • Suxamethonium apnoea (inheritance of a defective cholinesterase gene)
  • Reaction to anaesthetic drugs.
  • Ventilation perfusion mismatch (due to increased dead space and atelectasis)
  • Hypoventilation
  • Pneumonia
  • DVT/PE
  • Pressure sores
  • Post operative nausea and vomiting
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2
Q

What are the two main groups of immediate post operative complications?

A

Anaesthetic complications

Hammorrhage

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3
Q

What are the main early post operative complications?

A 
Fluid depletion 
Electrolyte imbalance 
Local infection 
Systemic infection 
Fluid collection 
Atelectasis 
DVT/PE 
Wound break down 
Anastamotic break down 
Bed sores
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4
Q

What are the specific risks of large and small bowel operations?

A 
Ileus 
Intestinal obstruction 
Anastomotic leaks 
Stoma retraction 
Intra abdominal collections 
Pre sacral plexus damage
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5
Q

What are the specific risks of cholecystectomy?

A

Common bile duct

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6
Q

What are the specific risks of vascular surgery?

A 
Haemorrhage
Graft failure 
Infection 
Re thrombosis 
Limb or organ ischaemia 
MI, CVA, PE
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7
Q

What are the causes of pyrexia on each of the days (0 - 10) after an operation?

A 
Less than 2 days: atelectasis 
2 - 4 days: pneumonia 
4 - 6 days: anastamotic leak or infection post operative collections 
6 - 8 days: wound infection 
8 - 10 days: PE/DVT
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8
Q

On what day post operatively does an anastamotic leak occur?

A

5 - 7

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9
Q

How and when does a wound infection tend to present?

A

2 -3 days after operation
Pain and swelling in the wound as well as systemic effects of infection such as malaise, anorexia and vomiting. The wound will be swollen hot and tender

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10
Q

How and when does an anastamotic leak tend to present?

A

Commonly occurs 5 - 7 days after surgery.

Presents with fever, oliguria, peritonitis and diarrhoea or ileus.

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11
Q

What is an anastamotic leak?

A

A leak of luminal contents from a surgical join between two hollow viscera. these are the most important complication to recognise following GI surgery (especially a risk in anastamosis in the oesophagus or rectum)

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12
Q

What might you see in the wound drain of someone with an anastamotic leak?

A

Feculant/purulent/bilous fluid

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13
Q

What investigations do you need to do if you suspect an anastamotic leak?

A

Blood tests: FBC, CRP, U & E’s, LFTs and clotting Raised WCC and CRP. Low albumin will all be seen
Venous blood gas (raised lactate indicates the degree of tissue perfusion)
Group and save as there will possibly be surgery
CT abdo and pelvis with contrast is needed as the definitive investigation

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14
Q

What is the definitive investigation for an anastamotic leak?

A

CT scan (Abdo and pelvis) with contrast

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15
Q

How do you manage an anastamotic leak?

A
  1. Nill by mouth. Broad spectrum antibiotics (Amox, met and gent)
    Catheter and IV fluids
    Minor leaks require observation and bowel rest. Major leaks require an exploratory laparatomy adnd might require subsequent surgical intervention with a stoma or stent.
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16
Q

What is a post operative ilues?

A

A deceleration or arrest in intenstinal motility following surgery (ie a functional obstruction of the bowel)

17
Q

What are risk factors for developing a post operative ileus?

A 
Elderly 
Electrolyte derangement 
Neurological disorders such as parkinsons or dementia 
Anti cholinergioi medications 
Opiod medication 
Pelvic surgery
18
Q

How does a post operative ileus present?

A 
Failure to pass flatus/faecus
Bloating/distention
Nausea/vomiting 
High NG tube outlet 
On examination there will be abdominal distention and absent bowel sounds (different from mechanical obstruction where there is tinkling bowel sounds)
19
Q

What investigations do you do if you suspect a paralytic ileus?

A 
Bloods (electrolyte abnormalities and inflammatory markers - these may suggest another diagnosis such as ana nastamotic leak) 
Abdo X Ray to look for dilatation 
CT scan (only really useful 3 -5 days after surgery
20
Q

What is the treatm,ent of a paralytic ileus (once other causes have been excluded)?

A

Daily U & Es (correct any abnormalities and look for AKI)
Mobilisation
Reduce opiates and other emdication that may cause constipation

21
Q

How can the risk of a post operative ileus be reduced?

A

Minimise intra operative handling
Avoid fluid overload
Minisime opiod use
Encourage early mobilisation

22
Q

What is an air leak?

A

Damage to the lungs which manifests as a persistent pneumothorax that fails to settle despite a chest drain.

23
Q

What is a chlye leak?

A

Damade to the lymphatic duct which causes a pale liquid to drain from the chest drain. Occurs in oesophagogastrectomy

24
Q

Is the risk of adhesions highr in open or laprascopc surgery?

A

Open

25
Q

What are early causes of post operative pyrexia (0 -5 days)?

A 
Blood transfusion
Cellulitis
UTI
Physiological systemic inflammatory reaction (usually occurs within 1 day)
Pulmonary atelectasis
26
Q

What are late causes of post operative pyrexia (over 5 days)?

A

Venous thromboembolism
Pneumonia
Wound infection
Anastamotic leak

27
Q

What is wound dehisence?

A

Rupture of a wound along a surgical incision. Signs include bleeding, pain, inflammation, fever or wound opening.
can be caused by subacute bacterial infection, excessive tension on the wound during surgery and in ehler danlos syndrome. Deep dehisence is when the bowel can be seen protruding through the would and is a surgical emergency.

28
Q

What is a hypertrophic scar?

A

Excessive amounts of collagen within a scar. Nodules may be seen. Remains within the boundires of the original scar.

29
Q

What is a keloid scar?

A

Excessive amounts of collagen within a scar that passes beyonf the boundries of the original injury. Do not conatin nodules and do not regress over time.

30
Q

What are risk factors for dehisence of an abdominal wound?

A

Pre op: Jaundice, obesity, steroids
Operative: Poor closing technique or poor quality sutures
Post op: Cough or abdominal distention which puts pressure on the wound

31
Q

What day post operatively does wound dehisence occur?

A

Day 10

32
Q

How does wound dehisence present?

A

Presents ond ay 10 with discharge of pink serous fluid. A loop of bowel or omentum can also protrude through

33
Q

How is deep wound dehisence treated?

A
  1. Morphine + anti emetic
  2. Saline soaked towel
  3. Patient prepared for surgery
34
Q

What is a post operative fistula?

A

An abnormal connection between two epithelial surfaces. Presents with the escape of bowel contents or bile through the wound or drainage site. the content of the drain depends on the structures involved:
Amylase: pancreatic
Biliary: Gall bladder
Creatanine: urinary tract

35
Q

How would you diagnose a post operative fistula?

A

Radio opaque dye + X Ray will tell you the location and extent of the fistula

36
Q

How do you treat a post operative fistula?

A
  1. Protect the surrounding skin
  2. replace fluid and electrolyte losses
  3. Reduce sepsis
  4. may have to retrun to theatre
37
Q

What examinations/investigations would you do for a post operative pyrexia?

A
  1. Inspect the wound
  2. Inspect venous canula sites (thrombophlebitis)
  3. Examine the chest (CXR/US/CTPA depending on findings)
  4. Examine the legs (DVT)
  5. Rectal exam (pelvic abscess)
  6. Urine culture
  7. Stool culture
  8. Review medications

General Surgery (10 decks)

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