S09C90 - Complications of General Surgical Procedures Flashcards
Fever
Causes: five Ws Wind - atelectasis, PNA, PE Water - UTI Wound Walking 0 DVT Wonder drugs or pseudomembranous colitis
1st 24h - atelectasis most common but can be nectrotizing strep or clostridial infxn
72h - usually respiratory and IV catheter related
1-5d post-op - UTI
7-10d post-op - wound infxns
5th day - DVT
Abx-induced pseudomembranous colitis can occur up to 6w post-op
Respiratory complications
- atelectasis
- PNA: 24-96h post-op, often polymicrobial, tx levo and vanco
- PTX: complications of thoracic surgery, breast bx, abdo lap Sx, paracentesis, NGT, CVC endoscopy, tracheostomy, shoulder arthroscopy
- PE
GU complications
- UTI: often e coli but also staph, strep epi, proteus, kleb, pseudo, entero, tx with cipro/levo
- urinary retention: occurs from catecholamine stimulation in bladder neck
- give Abx if there has been GU tract instrumentation or if prolonged retention
- if recent GU procedure then consult urologist
Acute Renal Failure
-irrigate/flush foley Prerenal: volume depletion Renal: ATN, drug nephrotoxicity Postrenal: obstructive uropathy -us to assess kidneys
Wound Complications
- surgeon should be contacted for all post-op wound infections
- hematoma
- seroma: caused by inadequate lymphatic drainage
- infxn - usually staph/strep, but if GI/biliary/perineum involved then polymicrobial with gm- and anaerobes
- necrotizing fasciitis: usually GAS or staph, Sx of systemic toxicity and pain out of proportion, tx Abx and surgical debridement, pcn or cephalosproin, aminoglycoside, and clinda
- dehiscence
Vascular complications
- superficial thrombophlebitis: redness and warmth of vein, if not signs of cellulitis or DVT then tx with heat, elevation and NSAIDs
- suppurative thrombophlebitis: erythema, palpable tender cord, lymphangitis, pain - tx is excision of vein
-DVT: us, if normal then elevate, if not better in 3d then rpt us
Medication complications
- pseudomembranous colitis (C. diff) from Abx use
- drug fever: aminoglycosides, metoclopramide, cephalosporines, haldol, heparin, nifedipine, vanco
Complications of breast surgery
- ptx
- hematomas
- seroma
- postmastectomy lymphedema
Complications of GI surgery
- obstruction: from stimulation of splanchnic nerve or from anaesthetic drugs, adynamic ileus is common – mechanical ileus usually due to adhesions
- abscess: investigate with CT/US
- pancreatitis: common after gastric recetion, biliary tract surgery, ERCP – n/v, pain, pleural effusion, hemorrhage (turner, cullen)
- cholecystitis
- fistulas
- tetanus: c tetani found in GIT of 1% of people, can occur 73d post-op
Anastomosis
- leaks more frequent in esophageal and colonic surgeries
- esophageal leak: 10d post-op, dramatic presentation, pain, CXR with PTX or pleural effusion
- gastric anastomosis leak: pain, fever, peritonitis, AXR with AF levels, volume resusc/abx/NGT/Sx
- small bowel anastomoses: usually local abscess formation or peritionitis
- colerectal anastomses leak: present 7-14d postop, CT/abx/ NGT/fluid/Sx
Bariatric surgery
- banding (lap-band), sleeve gastrectomy, roux-en-y bypass, biliopancreatic diversion with duodenal switch
- complications: anatomotic leak, hamorrhage in first few wks post-op, CT should be done with symptoms in post-op period
- roux-en-y complication: dumping syndrome, hyperosmolar chyme from stomach goes into jejunum 2-4h after eating causing a rapid influx of ECF and autonomic response (nausea, epigastric discomfort, palpitations, colicky abdo pain, diaphoresis, dizzy, syncope)
- early dumping (2h) have diarrhea
- late dumping d/t reactive hypoglycemia
- tx: dietary modification, small dry meals, separate solids fro liquids
-consider wernicke’s in pts with hx of bariatric surgery and cerebellar signs/ophthalmoplegia, weakness, memory disturbances (B12 deficiency)
Gastric sugery (nonbariatric) complications
-dumping syndrome
- alkaline reflux gastritis
- afferent loop syndrome: severe eipigastric pain 1-2h after eating, relieved by vomiting, dx with endoscopy, tx is operative re-construction
- postvagotomy diarrhea
Biliary tract surgery complications
- post-cholecystectomy - early post-op presentation: u/s or CT should be done to look for retained common duct stone, if these do not help the ERCP should be performed
- if late presentation there may be bile duct stricture - dx requires ERCP and stents
- bile leak, bile duct stricture, bleeding, bowel injury, intra-abdominal abscess, acute MI, pancreatitis, peritonitis, reained comon duct stones or stones in peritoneum, splenic injury, umbilical hernia, wound infxn
Stoma complications
- ischemia, necrosis, skin irritation, hernia, prolapse
- peristomal maceration: usually from poor seal of stomal appliance, have enterostomal therapist to see
- stomal prolapse: examine stoma, should be pink and painless, reduce if tissues are viable
- parastomal hernias
Colonoscopy complications
-hemorrhage, perforation, retroperitoneal abscess, penumoscrotum, PTX, volvulus, distention, splenic rupture, appendicitis, bacteremia, infxn
