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Gastro > Surgery of the GI tract and its complication > Flashcards

Surgery of the GI tract and its complication Flashcards

1
Q

What might happen to a wound

A

Become infected
Not heal properly
Break down

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2
Q

What is the problem with laproscopic surgery

A

Can’t see as much as open surgery

could create burns with instruments outwith view

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3
Q

What are the 3 main complications of Cardiovascular

A

Haemorrhage
MI
DVT

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4
Q

What are the 2 types of bleeding (haemorrhage)

A

Reactionary - immediately post op

Secondary - infection (5-10 days) uncommon

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5
Q

What are 4 presentations of haemorrhage

A

Overt
Tachycardia
Hypotension
Oliguria (low urine output)

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6
Q

How do we resussitate a patient with bleeding?

A

Fluids (increase BP and drop HR)

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7
Q

How can we prevent haemorrhage (3)

A

Meticulous technique
Avoidance of sepsis
Correction of coagulation disorders

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8
Q

What are the 2 main increased risk factors of MI

A

Severe angina

Previous MI

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9
Q

What is the mortality rate of MI with a bleed

A

50%

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10
Q

What is the presentation of a perioperative MI

A

Often silent
Cardiac faulure / cardiogenic shock
Arrythmias
May not have chest pain due to analgesia or anaesthetic

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11
Q

How can we prevent MI (3)

A

Delay surgery after MI by at least 6 months
Avoidance of perioperative hypotension
Correction of ischaemic heart disease (grafting and not stenting)

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12
Q

What is the benefit of grafting instead of stenting?

A

They don’t need antiplatelet agents such as clopidogrel so they future surgery is easier

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13
Q

What are the increased risk factors of DVT

A 
Age >40
Previous DVT
Major surgery 
Obesity
Malignancy
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14
Q

What causes DVTs?

A

Immobility during surgery

Hypercoagulability

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15
Q

What are the 5 common presentations of DVT

A 
Low grade fever (5-14 days)
Unilateral ankle swelling
Calf or thigh tenderness
Increased leg diameter
Shiny skin
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16
Q

What 3 things can we do to prevent DVT

A

Compression stockings
Low dose subcutaneous heparin
Early mobilisation

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17
Q

Why do we give Heparin before surgery sometimes?

A

Low doses of heparin is proven to prevent DVT

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18
Q

What are the 3 main respiratory complications

A

Atelectasis - collapse of the lung tissue
Pneumonia
Pulmonary embolism

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19
Q

What is atelectasiss

A

Collapse of lung tissue leading to infection

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20
Q

What are the risk factors of Atelectasis

A

Anaesthesia - increases secretion and inhibits cilia
Postoperative pain - inhibits coughing
Aspiration - stomach contents - damage from acid

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21
Q

How do chest infections commonly present?

A 
Low grade fever (0-2 days)
High grade fever (4-10 days)
Dyspnoea
Productive cough
Confusion often due to hypoxia
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22
Q

How do we try to prevent chest infections

A

Stopping smoking (even just a few days
Adequate analgesia - allows them to take deep breaths more easily and allow them to cough
Physiotherapy

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23
Q

What are the commmon presentations of PE

A

Tachypnoea
Dyspnoea
Confusion
Pleuritic pain

24
Q

How do we diagnose a PE

A

V/Q scan (ventilation perfusion scan)

25
Q

What does a PE look like on a CT scanner

A

White - fluid

26
Q

How can we prevent PE

A

Anticoagulation in presence of DVT
Early mobilisation
Lo-dose subcutaneous heparin
Compression stockings

27
Q

What are the 3 major GI complications

A

Ileus
Anastomotic dehiscence
Adhesions

28
Q

What is ileus

A

Paralysis of intestinal motility

29
Q

What causes ileus

A 
Handling the bowel
Peritonitis
Retroperitoneal injury - often RTA patients 
Prolonged Immobilisation
Hypokalaemia
Drugs
30
Q

What do ileus patients present with

A

Vomiting
Abdominal distension
Dehydration

31
Q

How do we prevent ileus

A

Minimal operative trauma
Laparoscopy
Avoidance of intra-abdominal sepsis

32
Q

What is an anastomotic breakdown

A

Not confined to the GI tract

Intestinal, vascular or urological

33
Q

What causes anastomosis

A

Poor technique
Poor blood supply
Tension on anastomosis

34
Q

What is the representation of vascular anastomosis

A

Bleeding /haematoma

35
Q

What is the urological presentation of anastomosis

A

Leakage of urine / urinoma

36
Q

What are the intestinal presentations of anastomosis

A

Peritonitis
Abscess
Ileus
Fistula

37
Q

How can we prevent anasatomitic dehiscence

A

Good technique

good blood supply

38
Q

What are adhesions particularly problematic for

A

Abdo surgery

39
Q

What do adhesions stick together?

A

Bowel to bowel
Bowel to abdo wall
Lung to chest wall

40
Q

What causes adhesions

A

Inflammatory response

Ischaemia

41
Q

How do adhesions present?

A

Usually asymptomatic - to chest wall

Intestinal obstruction - vomiting, pain, distension, constipation

42
Q

In what 4 ways can we prevent adhesions

A

No powder n gloves
Avoidance of infection
Laparoscopic surgery
Sodium hyaluronidate (chemical which can marginally reduce the risk- used on patient who gets recurrent adhesions)

43
Q

What can happen to the wound

A

Infection
Breakdown
Hernia

44
Q

What causes wound infection

A

Trauma - exogenous (RTA)

Intestinal surgery - endogenous

45
Q

What are the presentations of wound infection

A 
Pyrexia (5-8 days)
Redness
Pain
Swelling
Discharge
46
Q

How can we prevent wound infection

A 
Pre-op preparation
Skin cleansing
Aseptic technique
Avoidance of contamination
Prophylactic antibiotics
47
Q

What is pre-op preparation and why is it under question

A

Laxatives to clear the bowel - watery stool is often more likely to cause infection

48
Q

What are 4 complications of urinary surgery

A

Acute retention of urine
Urinary tract infection
Urethral stricture
Acute renal failure - with loss of blood if not properly resuscitated

49
Q

Who is most likely to get a UTI?

A

Those with a urethral catheter

50
Q

What are 3 complications of neurological surgery

A

Confusion
Stroke
Peripheral nerve lesions

51
Q

What are the causes of confusion

A 
HYPOXIA - chest infection, PE, MI
Oversedation
Sepsis
Electrolyte imbalance 
Stroke
Hyper or hypoglycaemia
Alcohol or tranquilliser withdrawl
52
Q

How does confusion present

A

Disorientation - time and place
Paranoia
Hallucinations - very common

53
Q

How can we prevent confusion

A

Maintain oxygen
Avoid dehydration
Avoid sepsis
Send home ASAP

54
Q

How can we minimise complications and their effect

A

Patients election and preparation
Careful surgery
Constant vigilance - early recognition of complications

55
Q

What are the 3 objective of enhanced recovery after surgery

A

Pain control
GI function
Mobility

Gastro (67 decks)

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