Surgery of the GI tract and its complication Flashcards
What might happen to a wound
Become infected
Not heal properly
Break down
What is the problem with laproscopic surgery
Can’t see as much as open surgery
could create burns with instruments outwith view
What are the 3 main complications of Cardiovascular
Haemorrhage
MI
DVT
What are the 2 types of bleeding (haemorrhage)
Reactionary - immediately post op
Secondary - infection (5-10 days) uncommon
What are 4 presentations of haemorrhage
Overt
Tachycardia
Hypotension
Oliguria (low urine output)
How do we resussitate a patient with bleeding?
Fluids (increase BP and drop HR)
How can we prevent haemorrhage (3)
Meticulous technique
Avoidance of sepsis
Correction of coagulation disorders
What are the 2 main increased risk factors of MI
Severe angina
Previous MI
What is the mortality rate of MI with a bleed
50%
What is the presentation of a perioperative MI
Often silent
Cardiac faulure / cardiogenic shock
Arrythmias
May not have chest pain due to analgesia or anaesthetic
How can we prevent MI (3)
Delay surgery after MI by at least 6 months
Avoidance of perioperative hypotension
Correction of ischaemic heart disease (grafting and not stenting)
What is the benefit of grafting instead of stenting?
They don’t need antiplatelet agents such as clopidogrel so they future surgery is easier
What are the increased risk factors of DVT
Age >40 Previous DVT Major surgery Obesity Malignancy
What causes DVTs?
Immobility during surgery
Hypercoagulability
What are the 5 common presentations of DVT
Low grade fever (5-14 days) Unilateral ankle swelling Calf or thigh tenderness Increased leg diameter Shiny skin
What 3 things can we do to prevent DVT
Compression stockings
Low dose subcutaneous heparin
Early mobilisation
Why do we give Heparin before surgery sometimes?
Low doses of heparin is proven to prevent DVT
What are the 3 main respiratory complications
Atelectasis - collapse of the lung tissue
Pneumonia
Pulmonary embolism
What is atelectasiss
Collapse of lung tissue leading to infection
What are the risk factors of Atelectasis
Anaesthesia - increases secretion and inhibits cilia
Postoperative pain - inhibits coughing
Aspiration - stomach contents - damage from acid
How do chest infections commonly present?
Low grade fever (0-2 days) High grade fever (4-10 days) Dyspnoea Productive cough Confusion often due to hypoxia
How do we try to prevent chest infections
Stopping smoking (even just a few days
Adequate analgesia - allows them to take deep breaths more easily and allow them to cough
Physiotherapy
What are the commmon presentations of PE
Tachypnoea
Dyspnoea
Confusion
Pleuritic pain
How do we diagnose a PE
V/Q scan (ventilation perfusion scan)
What does a PE look like on a CT scanner
White - fluid
How can we prevent PE
Anticoagulation in presence of DVT
Early mobilisation
Lo-dose subcutaneous heparin
Compression stockings
What are the 3 major GI complications
Ileus
Anastomotic dehiscence
Adhesions
What is ileus
Paralysis of intestinal motility
What causes ileus
Handling the bowel Peritonitis Retroperitoneal injury - often RTA patients Prolonged Immobilisation Hypokalaemia Drugs
What do ileus patients present with
Vomiting
Abdominal distension
Dehydration
How do we prevent ileus
Minimal operative trauma
Laparoscopy
Avoidance of intra-abdominal sepsis
What is an anastomotic breakdown
Not confined to the GI tract
Intestinal, vascular or urological
What causes anastomosis
Poor technique
Poor blood supply
Tension on anastomosis
What is the representation of vascular anastomosis
Bleeding /haematoma
What is the urological presentation of anastomosis
Leakage of urine / urinoma
What are the intestinal presentations of anastomosis
Peritonitis
Abscess
Ileus
Fistula
How can we prevent anasatomitic dehiscence
Good technique
good blood supply
What are adhesions particularly problematic for
Abdo surgery
What do adhesions stick together?
Bowel to bowel
Bowel to abdo wall
Lung to chest wall
What causes adhesions
Inflammatory response
Ischaemia
How do adhesions present?
Usually asymptomatic - to chest wall
Intestinal obstruction - vomiting, pain, distension, constipation
In what 4 ways can we prevent adhesions
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)
What can happen to the wound
Infection
Breakdown
Hernia
What causes wound infection
Trauma - exogenous (RTA)
Intestinal surgery - endogenous
What are the presentations of wound infection
Pyrexia (5-8 days) Redness Pain Swelling Discharge
How can we prevent wound infection
Pre-op preparation Skin cleansing Aseptic technique Avoidance of contamination Prophylactic antibiotics
What is pre-op preparation and why is it under question
Laxatives to clear the bowel - watery stool is often more likely to cause infection
What are 4 complications of urinary surgery
Acute retention of urine
Urinary tract infection
Urethral stricture
Acute renal failure - with loss of blood if not properly resuscitated
Who is most likely to get a UTI?
Those with a urethral catheter
What are 3 complications of neurological surgery
Confusion
Stroke
Peripheral nerve lesions
What are the causes of confusion
HYPOXIA - chest infection, PE, MI Oversedation Sepsis Electrolyte imbalance Stroke Hyper or hypoglycaemia Alcohol or tranquilliser withdrawl
How does confusion present
Disorientation - time and place
Paranoia
Hallucinations - very common
How can we prevent confusion
Maintain oxygen
Avoid dehydration
Avoid sepsis
Send home ASAP
How can we minimise complications and their effect
Patients election and preparation
Careful surgery
Constant vigilance - early recognition of complications
What are the 3 objective of enhanced recovery after surgery
Pain control
GI function
Mobility
