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Surgery complications Flashcards

1
Q

What causes a collapse of the alveoli

A

inadequate alveolar expansion, poor ventilation of lungs during surgery, high levels of inspired O2

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2
Q

SSx of postop atelectasis

A

Fever, decreased breath sounds with rales, tachypnea, tachycardia, increased density on CXR

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3
Q

RF of postop atelectasis

A

COPD, smoking, abd or thoracic surgery, oversedation, poor pain control

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4
Q

What percentage of PE are fatal

A

10-15%

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5
Q

Management of postop atelectasis

A

postop smoking cessation, incentive spirometry, good pain control

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6
Q

Respiratory impairment increased with

A

respiratory rate increased, SOB, dyspnea

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7
Q

Diagnosis of respiratory failure

A

PaO2 50

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8
Q

Management of post op respiratory failure

A

supp O2, chest PT, suctioning, intubation and ventilation

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9
Q

Risk factors for PE post op

A

hypercoagulability, venous stasis, endothelial injury

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10
Q

Ssx of postop PE

A

SOB, tachypnea, HTN, CP, lower extremity swelling, loud pulmonic component of S2

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11
Q

What is the mgmt of the postop pulmonary embolism

A

anticoagulation (heparin) +/- greenfield filter

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12
Q

Why can you not give coumadin postop

A

It causes a hypercoaguable state initally as it gets rid of proteins C and S first (the main anticoaguables)

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13
Q

What are the prevention for postop PE

A

sequential compression device, ambulation ASAP, anticoagulation

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14
Q

What is a saddle embolus

A

PE that straddles the pulmonary artery and is in the lumen of both the left and right pulmonary arteries

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15
Q

What is a definition of a greenfield filter

A

Metallic filter placed into Inferior Vena Cava via the jugular vein or femoral vein to catch emboli prior to lodging in the pulmonary artery

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16
Q

What are the indications of a greenfield filter

A

if anticoag contraindicated, further PE on adequate anticoag, prophylactic use in highrisk patients, if a seconf PE would be fatal

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17
Q

What can present like a PE?

A

MI, sepsis, pneumothorax, anemia, pneumonia

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18
Q

What patient’s are DVTs common

A

orthopedic, abdominal, pelvic

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19
Q

What is medelson’s syndrom

A

Chemical pneumonitis secondary to aspiration of stomach contents (gastric acid)

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20
Q

What are risk factors of aspiration pneumonia

A

intubation, impaired consciousness, nonfunctioning NGT, trendelenburg position, OR emergent intubation with full stomach

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21
Q

SSx of postop aspiration pneumonia

A

Respiratory failure, CP, increased sputum, fever, cough, mental status changes, tachycardia, cyanosis, infiltrate on CXR

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22
Q

Prevention of aspiration pneumonia

A

Avoid intubation and surgery in patients not NPO to solids x 6 hours and to liquids x 2 hours

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23
Q

common etiology of constipation

A

narcotics, immobility

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24
Q

treatment of constipation

A

docusate sodium qd if mild, miralax, milk of magnesia, bisacodyl suppositories, enema

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25
Etiology of small bowel obstruction
adhesions, malignancy, Crohn's disease, incarcerated hernia
26
ABCs for SBO
adhesions, bulge, cancer
27
History characteristics of SBO
N/V, fever, tachycardia, colicky pain
28
Treatment for SBO
NPO, NG tube, correct electrolytes, IV fluids
29
What is obstipation
nothing is passing through the bowel, no air or feces
30
what is constipation
air can pass through the bowel but feces cannot
31
what are placement complications of a NG tube
sinusitis, minor UGI bleeding, clogged, esophageal perforation
32
What are the causes of postop ileus
laparotomy, hypokalemia, narcotics, intraperitoneal infection, pain, intraperitoneal abscess, manipulation of bowel during surgery
33
Presentation of post op ileus
vague, mild abd pain d/t distenstion, bloating, N/V/anorexia, abdominal cramping
34
What is the recovery of bowel function in the small intestine
5-10 hours
35
What is the recovery of bowel function in the stomach
1-2 days
36
What is the recovery of bowel function in the colon
3-5 days
37
What are the SSX of gastric dilation
abd distention, hiccups, electrolyte abnormalities, nausea
38
What ist he treatment of gastric dilation
NGT decompression
39
Etiology of pancreatitis
manipulation of pancreas, decreased blood flow during procedure, gallstones, hypercalcemia, medications, idiopathic
40
What is short bowel syndrome
Malabsorption and diarrhea resulting from extensive bowel resection
41
SSx of short bowel syndrome
ABD pain, diarrhea, steatorrhea, dehydration, weight loss, malnutrition, fatigue
42
What is the treatment of short bowel syndrome
TPN Early, many small meals chronically
43
What is blind loop syndrome
Massive bacterial overgrowth in afferent limb of small intestine resulting in malabsorption
44
SSx of blind loop syndrome
anorexia/N/D, postprandial fullness, fatty stools, unintentional weight loss
45
Treatment of blind loop syndrome
Antibiotic, B12 supplement, surgery if necessary
46
What is afferent loop syndrome
result of mechanical obstruction of afferent limb near its attachment to the stomach
47
SSx of afferent loop syndrome
abd distention, abd pain, explosive vomiting of clear, bilious fluid after a large meal
48
Treatment of afferent loop syndrome
surgery: redo anastomosis, convert to Billroth I gastroduodenostomy, Roux-en-Y gastrojejunostomy
49
Ssx of efferent loop syndrome
diffuse abd pain, nausea, bilious vomiting
50
etiology of efferent loop syndrome
Partial or complete mechanical obstruction of the intestine near the gastrojejunostomy site
51
What is Roux Stasis syndrome
Slowed gastric emptying, and/or upper gut transit after Roux-en-Y gastrojejunostomy; N/V (nonbilious)
52
what is dumping syndrome
Delivery of hyperosmotic chye to the small intestine causing massive fluid shifts into the bowel (normally the stomach will decrease the osmolality of the chyme prior to its emptying)
53
What is post-vagotomy diarrhea
Intractable diarrhea after truncal vagotomy that does not improve in the months after surgery
54
SSx of post-vagotomy diarrhea
Postprandial: palpitations, sweating, nausea, cramps, vomiting, and diarrhea; Multiple, watery bowel movements daily; Diarrhea is often explosive and come without warning and with poor ability of the patient to control them
55
treatment for post-vagotomy diarrhea
loperamide and fiber-bulking agents
56
What are the Ssx of alkaline reflux gastritis
chronic, continuous epigastric pain worse with eating, bilious vomiting, weight loss, iron deficiency anemia, achlorhydria, gastritis, intragastric bile
57
Etiology of alkaline reflux disease
Bile and pancreatic juice from the afferent limb enter the stomach and are activated by foods which leads to hyperemia and erosions of the stomach
58
What is pouchitis
Inflammation of the ileal pouch, which was created in the management of ulcerative colitis or FAP
59
what are the ssx of pouchitis
bloddy diarrhea, urgency in passing stools, discomfort while passing stools, pain is rare with pouchitis
60
what is the treatment of pouchitis
cipro and flagyl
61
What is thyroid storm
Life-threatening condition manifested by marked increase in the ssxs of hyperthyroidism
62
SSX of thyroid storm
fever, diaphoresis, tachycardia, CHF, N/V, abd pain, AMS, HoTN (late)
63
Treatmetn of thyroid storm
PTU, Methimazole, or Radioactive iodine
64
What is diabetes insipidus
Decreased release of ADH, resulting in massive I̍s and O̍s
65
What are the characteristics of Central DI
head trauma or intracranial disorder
66
what are the characteristics of nephrogenic DI
renal disease, electrolyte disorder, medications
67
treatment of DI
vasopressin, IV fluids
68
what is SIADH
inappropriate release of ADH
69
What does DKA lead to
hyperglycemia, formation of ketoacids, osmotic diarrhea, metabolic acidosis
70
SSX of DKA
polyuria, tachypnea, dehydration, confusion, abd pain
71
What is the MC missed thing in DKA
perirectal abscess
72
what is the etiology of DKA
elevated glucose, increased anion gap, hypokalemia, urine ketones, acidosis
73
what is the treatment of DKA
insulin drip, IVF rehydration, IV K+ supp +/- bicarb
74
what is an Addisonian Crisis
Acute adrenal insufficiency in the face of a stressor
75
What are ssx of addisonian crisis
tachycardia, N/V/D, HoGlycemia, Hyperkalemic, Hypercalcemia, sudden penetrating Abd pai, +/- fever, AMS, HoTN, HoVolemic shock
76
Ewhat is the treatment of Addisonian crisis
IVFs, hydrocortisone IV, fludrocortisone PO
77
What is a fat embolism
Embolic marrow fat macroglobules damage small vessel perfusion leading to endothelial damage in pulmonary capillary beds leading to respiratory failure and ARDS like picture
78
What is DIC
Activation of coagulation cascade leading to thrombosis and consumption of clotting factors and platelets and activation of fibrinolytic system (fibrinolysis), resulting in bleeding
79
What are SSX of DIC
Diffuse bleeding from incision sites, venipuncture sites, catheter sites, mucus membranes

Surgical Medicine E1 (6 decks)

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