Surgery of the GI tract and its complication

Question 1

What might happen to a wound

Answer 1

Become infected
Not heal properly
Break down

Question 2

What is the problem with laproscopic surgery

Answer 2

Can’t see as much as open surgery

could create burns with instruments outwith view

Question 3

What are the 3 main complications of Cardiovascular

Answer 3

Haemorrhage
MI
DVT

Question 4

What are the 2 types of bleeding (haemorrhage)

Answer 4

Reactionary - immediately post op

Secondary - infection (5-10 days) uncommon

Question 5

What are 4 presentations of haemorrhage

Answer 5

Overt
Tachycardia
Hypotension
Oliguria (low urine output)

Question 6

How do we resussitate a patient with bleeding?

Answer 6

Fluids (increase BP and drop HR)

Question 7

How can we prevent haemorrhage (3)

Answer 7

Meticulous technique
Avoidance of sepsis
Correction of coagulation disorders

Question 8

What are the 2 main increased risk factors of MI

Answer 8

Severe angina

Previous MI

Question 9

What is the mortality rate of MI with a bleed

Answer 9

50%

Question 10

What is the presentation of a perioperative MI

Answer 10

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

Question 11

How can we prevent MI (3)

Answer 11

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

Question 12

What is the benefit of grafting instead of stenting?

Answer 12

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

Question 13

What are the increased risk factors of DVT

Answer 13

Age >40
Previous DVT
Major surgery 
Obesity
Malignancy

Question 14

What causes DVTs?

Answer 14

Immobility during surgery

Hypercoagulability

Question 15

What are the 5 common presentations of DVT

Answer 15

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

Question 16

What 3 things can we do to prevent DVT

Answer 16

Compression stockings
Low dose subcutaneous heparin
Early mobilisation

Question 17

Why do we give Heparin before surgery sometimes?

Answer 17

Low doses of heparin is proven to prevent DVT

Question 18

What are the 3 main respiratory complications

Answer 18

Atelectasis - collapse of the lung tissue
Pneumonia
Pulmonary embolism

Question 19

What is atelectasiss

Answer 19

Collapse of lung tissue leading to infection

Question 20

What are the risk factors of Atelectasis

Answer 20

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

Question 21

How do chest infections commonly present?

Answer 21

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

Question 22

How do we try to prevent chest infections

Answer 22

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

Question 23

What are the commmon presentations of PE

Answer 23

Tachypnoea
Dyspnoea
Confusion
Pleuritic pain

Question 24

How do we diagnose a PE

Answer 24

V/Q scan (ventilation perfusion scan)

Question 25

What does a PE look like on a CT scanner

Answer 25

White - fluid

Question 26

How can we prevent PE

Answer 26

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

Question 27

What are the 3 major GI complications

Answer 27

Ileus Anastomotic dehiscence Adhesions

Question 28

What is ileus

Answer 28

Paralysis of intestinal motility

Question 29

What causes ileus

Answer 29

``` Handling the bowel Peritonitis Retroperitoneal injury - often RTA patients Prolonged Immobilisation Hypokalaemia Drugs ```

Question 30

What do ileus patients present with

Answer 30

Vomiting Abdominal distension Dehydration

Question 31

How do we prevent ileus

Answer 31

Minimal operative trauma Laparoscopy Avoidance of intra-abdominal sepsis

Question 32

What is an anastomotic breakdown

Answer 32

Not confined to the GI tract | Intestinal, vascular or urological

Question 33

What causes anastomosis

Answer 33

Poor technique Poor blood supply Tension on anastomosis

Question 34

What is the representation of vascular anastomosis

Answer 34

Bleeding /haematoma

Question 35

What is the urological presentation of anastomosis

Answer 35

Leakage of urine / urinoma

Question 36

What are the intestinal presentations of anastomosis

Answer 36

Peritonitis Abscess Ileus Fistula

Question 37

How can we prevent anasatomitic dehiscence

Answer 37

Good technique | good blood supply

Question 38

What are adhesions particularly problematic for

Answer 38

Abdo surgery

Question 39

What do adhesions stick together?

Answer 39

Bowel to bowel Bowel to abdo wall Lung to chest wall

Question 40

What causes adhesions

Answer 40

Inflammatory response | Ischaemia

Question 41

How do adhesions present?

Answer 41

Usually asymptomatic - to chest wall | Intestinal obstruction - vomiting, pain, distension, constipation

Question 42

In what 4 ways can we prevent adhesions

Answer 42

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)

Question 43

What can happen to the wound

Answer 43

Infection Breakdown Hernia

Question 44

What causes wound infection

Answer 44

Trauma - exogenous (RTA) | Intestinal surgery - endogenous

Question 45

What are the presentations of wound infection

Answer 45

``` Pyrexia (5-8 days) Redness Pain Swelling Discharge ```

Question 46

How can we prevent wound infection

Answer 46

``` Pre-op preparation Skin cleansing Aseptic technique Avoidance of contamination Prophylactic antibiotics ```

Question 47

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

Answer 47

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

Question 48

What are 4 complications of urinary surgery

Answer 48

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

Question 49

Who is most likely to get a UTI?

Answer 49

Those with a urethral catheter

Question 50

What are 3 complications of neurological surgery

Answer 50

Confusion Stroke Peripheral nerve lesions

Question 51

What are the causes of confusion

Answer 51

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

Question 52

How does confusion present

Answer 52

Disorientation - time and place Paranoia Hallucinations - very common

Question 53

How can we prevent confusion

Answer 53

Maintain oxygen Avoid dehydration Avoid sepsis Send home ASAP

Question 54

How can we minimise complications and their effect

Answer 54

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

Question 55

What are the 3 objective of enhanced recovery after surgery

Answer 55

Pain control GI function Mobility