Post-operative complications Flashcards
What are 5 causes of early post-op pyrexia (0-5 days)?
- Blood transfusion
- Cellulitis
- Urinary tract infection
- Physiological systemic inflammatory reaction (usually within a day following the operation)
- Pulmonary atelectasis (lung collapse)
What are 5 late (>5 days) causes of post-op pyrexia?
- Venous thromboembolism
- Pneumonia
- Wound infection
- Anastomotic leak
What is paralytic ileus?
Common complication after surgery involving bowel, especially surgeries involving handling of bowel. No peristalsis, resulting in pseudo-obstruction
What are 4 causes of paralytic ileus excluding surgery?
- Chest infections
- Myocardial infarction
- Stroke
- Acute kidney injury
What are 3 things to test in the blood that should be done in cases of paralytic ileus, and what should be done in response?
- Deranged electrolytes can contribute to development of paralytic ileus, therefore check: potassium, magnesium, phosphate.
- Replace electrolytes intravenously, as bowel not functioning normally
What are 9 ways of averting surgical complications?
- WHO checklist
- Prophylactic antibiotics
- Assess DVT/PE risk, prophylaxis
- Mark site of surgery
- Use tourniquets with caution
- Remember danger of end arteries and in situations where they occur, avoid using adrenaline-containing solutions and monopolar diathermy
- Handle tissues with care - devitalised serves as nidus for infection
- Wary of coupling injuries when using diathermy during laparoscopic surgery
- Inferior epigastric artery is favourite target for laparoscopic ports and surgical drains
What is a common mechanism for injuring the accessory nerve?
Posterior triangle lymph node biopsy
What is a common mechanism for injuring the sciatic nerve?
Posterior aproach to hip
What is a common mechanism for injuring the common peroneal nerve?
Legs in Lloyd Davies position
What is a common mechanism for injuring the long thoracic nerve?
Axillary node clearance
What is a common mechanism for injuring the recurrent laryngeal nerve?
During thyroid surgery
What is a common mechanism for injuring the pelvic autonomic nerves?
Pelvic cancer surgery
What is a common mechanism for injuring the hypoglossal nerve?
During carotid endarterectomy
What is a common mechanism for injuring the ulnar and medican nerves?
During upper limb fracture repairs
What is a common mechanism of injury to the thoracic duct?
During thoracic surgery e.g. pneumonectomy, oesophagectomy
What is a common mechanism of injury to the parathyroid glands?
During difficult thyroid surgery
What is a common mechanism of injury to the ureters?
During colonic resections/ gynaecological surgery
What is a common mechanism of injury to cause bowel perforation?
Use of Verres needle to establish pneumoperitoneum
What is a common mechanism of injury to the bile duct?
Failure to delineate Calots triangle carefully, and careless use of diathermy
What is Calots triangle?
- Aka cystohepatic triangle;
- Medial border is common hepatic duct
- Inferior border is the cystic duct
- Superior border is the inferior surface of the liver
What is a common mechanism of injury to the facial nerve?
Always at risk during parotidectomy
What is a common mechanism of injury to the tail of the pancreas?
when ligating the splenic hilum
What is a common mechanism of injury to the testicular vessels?
During re-do open hernia surgery
What is a common mechanism of injury to the hepatic veins?
During liver mobilisation