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Surgical Medicine E1 > Surgery complications > Flashcards

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
Q

Etiology of small bowel obstruction

A

adhesions, malignancy, Crohn’s disease, incarcerated hernia

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26
Q

ABCs for SBO

A

adhesions, bulge, cancer

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27
Q

History characteristics of SBO

A

N/V, fever, tachycardia, colicky pain

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28
Q

Treatment for SBO

A

NPO, NG tube, correct electrolytes, IV fluids

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29
Q

What is obstipation

A

nothing is passing through the bowel, no air or feces

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30
Q

what is constipation

A

air can pass through the bowel but feces cannot

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31
Q

what are placement complications of a NG tube

A

sinusitis, minor UGI bleeding, clogged, esophageal perforation

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32
Q

What are the causes of postop ileus

A

laparotomy, hypokalemia, narcotics, intraperitoneal infection, pain, intraperitoneal abscess, manipulation of bowel during surgery

33
Q

Presentation of post op ileus

A

vague, mild abd pain d/t distenstion, bloating, N/V/anorexia, abdominal cramping

34
Q

What is the recovery of bowel function in the small intestine

A

5-10 hours

35
Q

What is the recovery of bowel function in the stomach

A

1-2 days

36
Q

What is the recovery of bowel function in the colon

A

3-5 days

37
Q

What are the SSX of gastric dilation

A

abd distention, hiccups, electrolyte abnormalities, nausea

38
Q

What ist he treatment of gastric dilation

A

NGT decompression

39
Q

Etiology of pancreatitis

A

manipulation of pancreas, decreased blood flow during procedure, gallstones, hypercalcemia, medications, idiopathic

40
Q

What is short bowel syndrome

A

Malabsorption and diarrhea resulting from extensive bowel resection

41
Q

SSx of short bowel syndrome

A

ABD pain, diarrhea, steatorrhea, dehydration, weight loss, malnutrition, fatigue

42
Q

What is the treatment of short bowel syndrome

A

TPN Early, many small meals chronically

43
Q

What is blind loop syndrome

A

Massive bacterial overgrowth in afferent limb of small intestine resulting in malabsorption

44
Q

SSx of blind loop syndrome

A

anorexia/N/D, postprandial fullness, fatty stools, unintentional weight loss

45
Q

Treatment of blind loop syndrome

A

Antibiotic, B12 supplement, surgery if necessary

46
Q

What is afferent loop syndrome

A

result of mechanical obstruction of afferent limb near its attachment to the stomach

47
Q

SSx of afferent loop syndrome

A

abd distention, abd pain, explosive vomiting of clear, bilious fluid after a large meal

48
Q

Treatment of afferent loop syndrome

A

surgery: redo anastomosis, convert to Billroth I gastroduodenostomy, Roux-en-Y gastrojejunostomy

49
Q

Ssx of efferent loop syndrome

A

diffuse abd pain, nausea, bilious vomiting

50
Q

etiology of efferent loop syndrome

A

Partial or complete mechanical obstruction of the intestine near the gastrojejunostomy site

51
Q

What is Roux Stasis syndrome

A

Slowed gastric emptying, and/or upper gut transit after Roux-en-Y gastrojejunostomy; N/V (nonbilious)

52
Q

what is dumping syndrome

A

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
Q

What is post-vagotomy diarrhea

A

Intractable diarrhea after truncal vagotomy that does not improve in the months after surgery

54
Q

SSx of post-vagotomy diarrhea

A

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
Q

treatment for post-vagotomy diarrhea

A

loperamide and fiber-bulking agents

56
Q

What are the Ssx of alkaline reflux gastritis

A

chronic, continuous epigastric pain worse with eating, bilious vomiting, weight loss, iron deficiency anemia, achlorhydria, gastritis, intragastric bile

57
Q

Etiology of alkaline reflux disease

A

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
Q

What is pouchitis

A

Inflammation of the ileal pouch, which was created in the management of ulcerative colitis or FAP

59
Q

what are the ssx of pouchitis

A

bloddy diarrhea, urgency in passing stools, discomfort while passing stools, pain is rare with pouchitis

60
Q

what is the treatment of pouchitis

A

cipro and flagyl

61
Q

What is thyroid storm

A

Life-threatening condition manifested by marked increase in the ssxs of hyperthyroidism

62
Q

SSX of thyroid storm

A

fever, diaphoresis, tachycardia, CHF, N/V, abd pain, AMS, HoTN (late)

63
Q

Treatmetn of thyroid storm

A

PTU, Methimazole, or Radioactive iodine

64
Q

What is diabetes insipidus

A

Decreased release of ADH, resulting in massive I̍s and O̍s

65
Q

What are the characteristics of Central DI

A

head trauma or intracranial disorder

66
Q

what are the characteristics of nephrogenic DI

A

renal disease, electrolyte disorder, medications

67
Q

treatment of DI

A

vasopressin, IV fluids

68
Q

what is SIADH

A

inappropriate release of ADH

69
Q

What does DKA lead to

A

hyperglycemia, formation of ketoacids, osmotic diarrhea, metabolic acidosis

70
Q

SSX of DKA

A

polyuria, tachypnea, dehydration, confusion, abd pain

71
Q

What is the MC missed thing in DKA

A

perirectal abscess

72
Q

what is the etiology of DKA

A

elevated glucose, increased anion gap, hypokalemia, urine ketones, acidosis

73
Q

what is the treatment of DKA

A

insulin drip, IVF rehydration, IV K+ supp +/- bicarb

74
Q

what is an Addisonian Crisis

A

Acute adrenal insufficiency in the face of a stressor

75
Q

What are ssx of addisonian crisis

A

tachycardia, N/V/D, HoGlycemia, Hyperkalemic, Hypercalcemia, sudden penetrating Abd pai, +/- fever, AMS, HoTN, HoVolemic shock

76
Q

Ewhat is the treatment of Addisonian crisis

A

IVFs, hydrocortisone IV, fludrocortisone PO

77
Q

What is a fat embolism

A

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
Q

What is DIC

A

Activation of coagulation cascade leading to thrombosis and consumption of clotting factors and platelets and activation of fibrinolytic system (fibrinolysis), resulting in bleeding

79
Q

What are SSX of DIC

A

Diffuse bleeding from incision sites, venipuncture sites, catheter sites, mucus membranes

Surgical Medicine E1 (6 decks)

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