SURG consents Flashcards
Spinal anaesthesia
Less risk of a chest infection after surgery
Less effect on lungs and breathing
Excellent pain relief immediately after surgery
Less need for strong pain-relieving medicines and their side effects, including nausea, confusion, drowsiness and constipation
Less sickness and vomiting
Quicker return to drinking and eating after surgery
Less risk of becoming confused after the operation, especially if you are an older person
Improved bowel recovery
Improved blood flow after vascular surgery
See baby straight away
Risks Low blood pressure N and V Shivering Itching Urinary retention pain during the injection headache Bruising Pain and tenderness at the injection site Aches and pains Prolonged numbness and tingling Chest infection
Uncommon side effects Severe headache Temporary nerve damage Overdose of medicines which --> slow breathing Anaesthetic does not fully work Allergic reaction Existing medical problems getting worse
Rare side effects Permanent nerve damage --> possible paralysis Severe breathing difficulty Injection Short term deafness Double vision Blood clot with spinal cord damage Serious allergic reaction Equipment failure Leaking of stomach content into the lungs Seizures Meningitis Cardiac arrest Severe harm or death
Breast - Fibroadenoma/Ctst
Bruising around site Depression in breast at site of lump Scarring may pull nipple out of shape Thickened or red coloured scar Further necessary surgery if inadequate pathology test
Breast - FNA
Bruising
Need further biopsy
Innacurate report
Collapse of lung
Breast - WLE +/- SLNB
Operation site continues to ooze
Layers of wound not healing adequately –> long term wound care and antibiotics
Loss of sensation to nipple
Wound not healing normally
Swelling of arm
Loss of sexuality, depression, emotional issues
Regrowth of tumour
Risks of SLNB
<1% risk of missed lymph node spread
Small risk of incorrect information
Axillary dissection if positive, or unable to find SLNB
Anaphylaxis to dye, dye stain, blue/green pee for a while after
If in abnormal site - partial separation of ribs / risk of lung injury
Small radiation risk
SLNB - reduced lymphedema risk, reduced shoulder stiffness, reduced risk of numbness of axilla
Mastectomy
Continuous oozing Edges of wound change colour --> need further surgery Weakness and numbness of arms and chest Difficulty with arm movement Layers of wound may not heal --> burst open Wound --> thickened and painful Swelling of arm Recurrence of tumour Chronic pain Depression, anxiety, loss of sexuality
Breast tissue biopsy
Bruising around operation site Depression of breast at site Nipple out of shape Scar thickened and red coloured Further treatment - pathology
Breast Abscess / Haematoma
Wound continue to drain for some time and require dressings
Incision may not drain away all the fluid
Final healed scar thickened and painful and coloured
Alteration in shape
CABG/Vlave surgery - ONLY COS I SAW like 50 on cardio-thoracics so i know it - not necessary for exams
Common Bleeding Dysrhthmias - usually tmporary Short term memory, cognition, visual blurring Chest wall pain --:> sometimes chronic Breathlessness and easy tiring Wound may not heal properly Numbness on left side of chest due to harvesting the donor artery Blood clot in the leg - DVT
Uncommon Lung collapse Kidney failure if kidney problems Infection in the chest, breastbone, blood, leg or arm wounds Heart attack Graft blocked with a blood clot Leaking of a valve Respiratory failure Changes in heart rhythm BE Blood transfusions Stroke Death -N.B. SUPER HIGH RISK OF DYING IF jehovah's witness
Angiogram +/- angioplasty and stenting
Bruising at puncture site - sometimes major bruising
Re-narrowing
Loss of pulse in arm if radial arm procedure
Uncommon
Abnormal heart rhythm
Heart attack
Surgical repair of the groin/arm puncture site
Rare risks
Stent may suddenly close within first month –> angina or heart attack –> may need another angioplasty
Emergency heart surgery due to complications
A reaction to the medications given to prevent blood clotting
Minor reaction to the X-ray dye like hives, or loss of kidney function, or major reaction
Stroke
Higher lifetime risk of cancer from x-ray exposure
Rupture of a blood vessel requiring surgical repair and blood transfusion
Skin injury from radiation, causing reddening of the skin
Death as a result of the procedure is rare
Exercise stress test
Mild angina
SOB
MSS discomfort
Low BP - uncommon
Rare Fainitng Arrhytmia FLuid in lungs Severe chest pain heart attack Death
OPEN appendectomy
Deep bleeding Infections Weakness in wound Wound thickened and red Adhesions Fistula between stump and wound
Anal sphincter
Bleeding from site Deep abscesses Wound thickened and red Muscular control of anus not fixed Operation may not fix condition
BLOOD and Blood products consent (for jehovahs)
High temperature
Rash, itching, hives
Feeling a bit unwell
Rare: Having too much blood/fluids --> SOB Haemolysis Antibodies --> complicate future or later on Lung injury Spread of viral or other infections Very rarely, cause death
Ileostomy/Colostomy
Deep bleeding
Bowel closure may leak and infection develop
Loose bowels initially - temporary
Adhesions
Weakness around wound - rupture - further surgery
Healing may be abnormal - thickened, and scar may be painful
Fistula - Faecal/ Small bowel / Gastric
Difficulty in passing urine
Deep bleeding
part of bowel may need removal
Damage to other parts of the bowel
Infections such as pus collections
The bowel movement may be paralysed or blocked
Weakness can occur in the wound with complete or incomplete
Wound can thickened and red
Adhesions may form and cause bowel obstruction
Fistula may occur
Haemorrhoidectomy
Pain and bleeding
Difficulty passing urine
Tissues about the anus may swell and bruise
Blood may be passed with bowel actions for some days after the operation
Heavy bleeding from haemorrhoid wound may occur up to 1-2 weeks
Skin tags
The anus may scar up in the years to come and cause stricture
More haemorrhoids may occur in the future
Uncommon risks and complications: Anal fissure Incontinence of faeces or flatus Heart attack or stroke Blood clot - DVT
Rare risks and complications:
Extensive skin necrosis and infection around the area requiring further surgery
Death
Haemorrhoid - Staple
Difficulty passing urine Tissues above the anus Infection in the stapled area in 1/8 cases Heavy bleeding from haemorrhoid Anus may scar in the years More haemorrhoids can occur
Large bowel resection
Bowel movement may be paralysed
Ileus - N + V
Leakage of anastomosis if done
Weakness in wound
Some cases healing abnormal - thickened and red
Adhesions
The bowel actions may be looser than before
Section that is removed will be examined by a pathologist
Increased risk in smokers of wound and chest infections
Small areas of lung can collapse, increasing the risk of chest infection
Infections
Uncommon risks and complications: Deep bleeding Bleeding Heart attack or stroke DVT Death
Rare:
Surgical damage to nearby organs –> further surgery
Formation of blood clots in the veins near the bowel –> further treatment
Lateral Sphincterotomy / Anal stretch / Treatment of Anal Fissure
Heavy bleeding may occur from the wound 1-2 weeks after surgery
The condition can recur –> further surgery
Rarely the muscles at the anus may be over stretched or over cut with a resultant weakness in the area –> could cause problems with control of the bowels –> wear pad
Sigmoidoscopy
Mild pain and discomfort in the abdomen for 1-2 days after the procedure –> settles with walking, moving around
Uncommon:
1/5000 - perforation
Missed polyps, growths or bowel disease
Bleeding - 1/1000 risk, 1/100 if polyp removed
Rare:
Bacteraemia
Death
If sedation: N+V Faintness, dizziness Headache Pain, redness or bruising at sedation site Muscle aches and pains Allergy Dead arm Worsening existing medical condition Anaphylaxis Heart and lung problems Stroke
Resection of Rectum
Leakage where bowel was stitched together
Deep bleeding
Ileus
Infected wound
UTI
Infection in abdomen
Stoma - failed blood supply (further surgery), excess fluid loss, stoma prolapse, parastomal hernia, local skin irritation
Bleeding into abdomen
Damage to ureter
Abnormal emptying of bladder
Inability to have and/or maintain erection / dyspareunia in woman
Abnormal wound – thickened red and painful
Looser bowel actions
Adhesions
1/16-1/63 chance of death
Total colectomy / Excision of Rectum and Ileoanal reservoir - non malignant
Leakage 1/22-1/20 risk –> further surgery
Ileoanal pouch may become inflamed –> further therapy
Bowel doesn’t function properly in 1/13 - further surgery may be required
Excess fluid loss from stoma
Wound infected in 1/9
UTI in 1/20
Infection in abdominal cavity
Blood supply to the stoma – further surgery
Stoma prolapse
Parastomal hernia
Local skin irritation
Bleeding into wound for 1/35-1/28 - transfusion or further surgery
Damage to ureter
Urinary bladder problem
Healing of wound - thickened red and painful
Sexual dysfunction due to nerve damage
Change in bowel functioning
Adhesions
Death 1/16-1/20
Thyroid Surgery
Bleeding in tissues of neck - emergency surgery (pressure on windpipe)
Horase voice from recurrent laryngeal nerve
Hypocalcemia due to parathyroid
Need thyroid supplements
Keloid scar
Hernia - Incisional/Epigastric/Umbilical/Other
Common: Infections Bleeding Scar can thicken, red, and painful Hernia may come back Recurrent hernia with or without mesh Bleeding if taking thinners Seroma Atelectasis
Uncommon:
Heart attack or stroke
DVT / PE
Rare:
Adhesions
Death
Laparotomy
Deep bleeding Damage to bladder, bowel Infections in abdomen Iléus or long term blockage Adhesions Thickened, red and painful wound Poor wound healing - burst open Fistula Pain may not resolve or worsen No cause found
Inguinal Hernia Repair
OPEN: Trouble passing urine - spasm of sphincter for bladder Swelling of testicle and scrotum Infections Bleeding Chronic groin pain/numbness Postoperative scarring --> chronic pain Testicle sit a little higher Scar can thicken, turn red and may be painful Hernia may come back Operating on a recurrent hernia with or without previously inserted mesh or stitches may increase the risk of infection and bleeding and pain and recurrence More bleeding on blood thinners Small areas of lung collapse
Uncommon:
Partial vasectomy
Heart attack or stroke
DVT
Rare:
Adhesions and bowel obstruction
Damage and swelling with testicle loss
Death
LAPARACOPIC: Trouble passing urine due to spasm Swelling of testitcle and scrotum Partial vasectomy Chronic pain Hernia re-occur Bleeding can occur - More common if on blood thinners Seroma Atelectasis
Uncommon:
Change to open
Damage to large blood vessels, gut or bladder
Rarely gas, can cause heart and lung complications
Testicle may sit higher
Adhesions
Hernia where instruments passed in
Infections can occur, requiring antibiotics and further treatment
Heart attack, stroke
DVT
Rare:
Death
Burn/Wound Debridement
Infections
Bleeding
- Blood thinning –> more risk
Atelectasis
Uncommon:
Heart attack or stroke
Blood clot in leg
Rare:
Death
Skin Graft
Infections
Bleeding
Atelectasis
Skin graft - may not take, will not look normal, look different colour
Donor site - fluid discharge for long period of time, healing slow, thickened, discoloured or painful
Thickening and contraction of tissues –> difficulty in movements of the burnt area
Uncommon:
Heart attack or stroke, DVT, rejection of skin
Rare:
Death
Ramstedt’s
Hole in stomach lining Damage to bowel Deep bleeding Ileus Weakness in wound - hernia Vomit for some days after More surgery for more muscle dividing Abnormal wound healing Adhesions
Circumcision
Poor cosmesis Tip injured Raw and bleeding end of penis More skin may need to be removed Scar --> blockage of urine flow
Cholecystectomy - Laparascopic
Large blood vessels ->> bleeding Damage to gut/and or bladder when instruments Heart and breathing problems from gas May need to change to open Stones found outside gallbladder AND/OR may spill out and be lost Some stones left behind in bile duct Clips or ties may come off Damage to bile tubes Abnormal wound healing Hernia Adhesions No improvement in symptoms Allergic reaction to contrast
IF NOT DONE 50% recurrence in 5 years, or can get o0pen or cholecystomy (Longer stay and longer hospital recovery time)
Cholecystectomy Open
Damage to blood vessels
Gallstones spilt –> abscesses –> drainage
Left behind in bile duct (stones)
T tube out of position - further surgery required to re-insert the T-Tube
Metal clips may come off –> bile leak or bleeding
Damage to bile tubes –> chronic leakage or blockage problems
2-3 weeks T tube taken out –> bile leak into abdomen
Infection
Wound abnormal healing
Bleeding into wound
Hernia
Adhesions
Symptoms persisting
Allergic reaction to contrast
ERCP
1/20 pancreatitis - pain relief, usually settles but can be severe
N+V
Headache
Pain, redness or bruising at sedation injection site
Muscle aches and pains
Allergy to medications
Uncommon: <1/200 bleed 1/100 tear through bowel or duct wall - drainage tube Bacteraemia Technical issues Heart and lung problems GA from LA Dead aarm Worse existing medical condition
Rare: Systemic and cerebral air embolism Stroke --> brain damage Anaphylaxis Death
Whipple’s
Leakage of pancreatic, bile or gastric juices Difficulty in passing urine Deep bleeding Damage to bowel Infections Ileus Weakness in wound Abnormal wound healing Adhesions Feeling after meals called dumping Nutritional problems due to removal of part of stomach
TURP
Bleeding Late bleeding Mild to moderate difficulty with erection Urinary retention Retrograde ejaculation Inability to pass urine - reinsertion of catheter Swelling and pain in testicles Stricture - urethra or at bladder neck Incontinence urinary Damage to rectum 1/6 no improvement of symptoms
Vasectomy
Slowed heart beat and feel faint during operation
Bruise in scrotum
Alternative contraception until ejaculate tested
Repeat operation required
Small chance vas rejoins spontaneously –> no longer sterile (Reversals not available under medicare and expensive)
Painful area in testicle and swollen
Cyst back of testicle
Inflammatory nodules around cut ends of vas or in epididymis
Long term aching
Fistula between cut vas and skin - surgery
Cystoscopy and Retrograde Pyelogram +/- stent insertion
Allergic reaction to contrast
Rarely damage to urethra
Damage to bladder
Swelling at exit of bladder - need catheter
Bacteria in blood stream
Tube passes outside ureter into tissues
Bleeding may stain urine and cause blockage
Burning and scalding of urine for a few days after usually settles
No catheter passed through due to blockage
Indwelling stent –> irritation and blood occasionally - usually removed after a few weeks
Damage to ureter –> stricture –> further operation
Cystoscopy and lithotripsy
Damage to urethra Damage to bladder Swelling at exit of bladder --> urianray retention Bacteria in blood Bleeding stains or blocks urine Burning and/or scalding Catheter not able to be passed through ureteric opening Damage to ureter --> stricture
Cystoscopy and cathether
Allergic reaction to contrast Damage to urethra - false passage Damage to bladder Damage to ureter Blocked catheter due to blockage Swelling at exit of bladder Staining of blood / blockage Bacteria in blood stream Burning and scalding of urine for a few days
Radical Prostatectomy
Bleeding Erection difficulty Incontinence No ejaculation Damage to rectum or ureters Late bleeding Bladder muscle weakenss Swelling and pain in testicles Urinary leak Stricture Cancer recur Hernia of wound Death due to complications 1/200
6 week recovery
1-2 weeks in hospital with catheter
Nephrectomy
Failure of kidney function Major bleeding Urine leak from remaining kidney Removal of rib sometimes Difficulty in passing urine - catheter usually temporary Damage to bowel Ileus Abnormal wound healing Adhesions
Femoropopliteal Bypass
Graft block and no improvement –> worse circulation
Infection in the wounds
Groin wounds may discharge clear fluid called lymph for sometime
Healing abnormal - keloid scar (MOST VASC and thyroid have keloid scars FYI)
Leak –> false aneurysm
Leg usually swells after surgery
Nerve injury
Synthetic graft if no vein
Graft infected –> limb loss
Carotid Endarterectomy
Minor or major stroke Immediately after - Bleeding, breathing issues, 1/25 stroke, vein patch rupture in 1/100 Blood loss - transufions Cranial nerve injury 1/20 - 1/50 wound may leak Patch infection 1/100 Hyperperfusion syndrome - headache, fitting and haemorrhage Healing of wound --> abnormal --> keloid scar Numbness in neck Difficulty swallowing and talking Horaseness in voice - usually temporary Block in artery
AAA
Graft leak
Deep bleeding
Damage to blood supply kidney, gut –> strictures or peritonitis
Failure of lungs
Damage to bowel –> colostomy
Infections
Ileus
Weakness in wound, rupture
False aneurysm
Graft may stick to gut –> connection –> 1/2 chance of death
Adhesions
Paraplegia (blood supply spinal cord) –> 1/1000 permanent disability
Blockage of the graft –> loss of limb
Blockage of blood flow to buttock –> pain on walking
Retrograde ejaculation 1/6
Inability to pass urine –> catheter - can be long term
Death 1/20, Major complications 1/10
Amputation
Blood supply to tissue not sufficient - further amputation
Woundd slow healing
Phantom limb
Fixed in position - unable to use prosthesis
Keloid scar
Loose skin adjustment
No functional return
Varicose Veins
Hard tender lumps Skin about lower leg is thin --> ulcers Damage to deeper veins Some remain Nerve --> numbness in foot Keloid scar
Oesophagoscopy
Lips, teeth, gums, tongue injury, dental too
Perofration or rupture of oesophagus –> larynx injury, prolonged stay
Voice change
Reflux Operation
Laparascopic: Open 1/20 failure of TV Damage to Large BV, Gut Gas --> lung and heart issues in 1/100 Deep bleeding Damage to oesophagus Damage to bowel Damage to spleen Male - difficulty in urine Infections Ileus Swallowing, belching and vomiting difficulty Vagus nerve damage - delay in empyting Adhesions Recurrence Healing abnormal
OPEN:
Same as above
Hysterectomy
Common: Pain in abdomen and shoulders N and V Menopause Infection Bleeding Lapartomy from less invasive Atelectasis No cause for symptoms Wound infection, chest, heart and lung Blood clot
Uncommon: Poor wound healing Wound thickened (abdominal) Prolapse (for vaginal only) Dyspareunia (vaginal only) Adhesions DVT Hernia
Rare: Damage to ureters, bowel blockager Fistula Heart attack or stroke Death very rare
D and C
Damage to cervix, uterus (perforation sometimes) Severe bleeding Infgection Tissue may not all be removed Air in blood stream - fatal 10-14 days bleeding Late first period after
Ovarian Cystectomy/Oophorectomy +/- Salpingectomy
Common: Pain in abdomen and shoulders (gas) N and V Open may be needed Infection Bleeding Atelectasis No cause for symptoms
Uncommon: Menopause Blockage of bowel Poor wound healing Keloid Hernia Adhesions Need to take out ovaries when not originally planning too DVT
Rare:
Damage to ureters,
Gas causing lung and heart issues
Termination of Pregnancy
SURGICAL: Common: Infections Bleeding Atelectasais
Uncommon:
Damage to cervix, heart attack, blood clot
Rare:
Scarring, damage to uterus (perforation), damage to bowel (colostomy - may be permanent)
Air embolism
MEDICAL:
Infections, bleeding, incomplete passage –> surgery
Uncommon - DVT
Rare - Rupture of uterus, further attempt after 2-3 days –> laparotomy –> hysterectomy –> somtimes even hysterectomy
Heart attack or death very rare
Vaginal mesh
Difficulty passing urine Bladder and bowel habit changes Failure of procedure and recurrence of prolapse Temporary local irritation pain in pelvic area, even during intercourse Infection Bleeding Atelectasiss
Uncommon:
Stress incontinence
Scarring or narrowing or shortening of vagina
Perineal pain
Chronic permanent nerve buttock pelvic pain
Adhesion
Seroma
Lacerations of vessels nerves, structures, or organs - ureter, vagina or bowel
DCT
Rare - Fistula between vagina and bladder OR rectum
Heart attack, stroke or death
