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Clinical > Surgical Complications > Flashcards

Surgical Complications Flashcards

1
Q

Classifications of complications of surgery?

A

General (any operation)

Specific (particular operation)

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2
Q

How should complications be approached?

A 
Systematically:
CVS
Respiratory
GI
Urinary 
Neurological
Wound
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3
Q

What are the CVS complications of surgery?

A

Haemorrhage
MI
DVT

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4
Q

Types of haemorrhage in surgery?

A

Reactionary (most common) - occurs immediately post-operative

Secondary (uncommon due to antibiotics)- due to infection; occurs within 5-10 days

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5
Q

Presentation of haemorrhage?

A

Overt

With loss of blood, blood pressure decreased and, in compensation, tachycardia occurs

Oliguria

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6
Q

Prevention of haemorrhage?

A

Meticulous technique

Avoidance of sepsis

Correction of coagulation disorders e.g: medications and some Jaundice patients cannot absorb vitamin K

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7
Q

When is MI risk in an operation increased?

A

If there is severe angina

If the person has had a previous MI:
30% within 3 months
Stabilises at 5 months in 6 months

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8
Q

How does peri-operative MI present?

A

Often silent, due to anaesthesia

Cardiac failure/cardiogenic shock

Arrhythmias

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9
Q

Prevention of a peri-operative MI?

A

Delay surgery after MI

Avoidance of peri-operative hypotension

Correction of ischaemic heart disease

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10
Q

Risk factors for DVT?

A 
Age >40
Previous DVT
Major surgery
Obesity
Malignancy
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11
Q

Causes of DVT?

A

Immobility during surgery

Hypercoagulable state

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12
Q

Presentation of DVT?

A

Low grade fever within 5-14 days

Unilateral ankle swelling; calf/thigh tenderness

Increased leg diameter

Shiny skin

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13
Q

Investigations for DVT?

A

D-dimer (degradation product of fibrin) test is a good rule-out test; if normal, it is unlikely to be a DVT

Proceed with other investigation if abnormal or if there is a high clinical suspicion of DVT:
Doppler ultrasound
Venography

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14
Q

Prevention of DVT?

A

Compression stockings

Low-dose subcutaneous heparin

Early mobilisation

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15
Q

Respiratory complications of surgery?

A

Atelectasis

Pneumonia

Pulmonary embolus (PE)

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16
Q

What is atelectasis and how can it cause pneumonia?

A

Partial collapse or incomplete inflation of the lung; this can lead to infection

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17
Q

Causes of atelectasis and pneumonia?

A

Anaesthesia

  • Increases secretion
  • Inhibits cilia

Postoperative pain
- Inhibits coughing

Aspiration
- Stomach contents

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18
Q

Presentation of chest infection?

A

Low grade fever (0-2 days) - most people will have this following surgery

High grade fever (4-10 days)

Dyspnoea

Productive cough

Confusion

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19
Q

Prevention of post-operative chest infection?

A

Stopping smoking

Adequate analgesia

Physiotherapy, part, for those who have lung disease

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20
Q

Risk factors for PE?

A 
Same as for DVT (cause):
Age > 40
Previous PE
Major surgery
Obesity
Malignancy
21
Q

Presentation of PE?

A 
Tachypnoea
Dyspnoea
Confusion
Pleuritic pain
Haemoptysis
Cardiopulmonary arrest
22
Q

Tests for PE?

A

V/Q scan (abnormal) - mismatch will be present; there will be ventilation but less perfusion

CTPA is gold-standard

23
Q

Prevention of PE?

A

Compression stockings

Low-dose subcutaneous heparin

Early mobilisation

Anti-coagulation in presence of DVT

24
Q

GI complications of surgery?

A

Ileus - paralysis of intestinal motility

Anastomotic dehiscence - Breakdown of anastomosis, e.g: intestinal, vascular, urological

Adhesions - fibrin (inflammatory response) is laid down to produce a fibrous tissue, e.g: bowel-bowel, bowel-abdominal wall and other structures and lung-chest wall

25
Q

Causes of ileus?

A 
Handling of bowel
Peritonitis
Retroperitoneal injury
Immobilisation
Hypokalaemia
Drugs
26
Q

Presentation of ileus?

A

Vomiting

Abdominal distension

Dehydration

Silent abdomen

27
Q

Prevention of an ileus?

A

Minimal operative trauma

Laparoscopy

Avoidance of intra-abdominal sepsis

28
Q

Causes of anastamotic dehiscence?

A

Poor technique

Poor blood supply

Tension on anastomosis (stretching)

29
Q

Presentationof anastamotic dehiscence?

A

Intestinal - peritionitis, abscess, ileus, fistula

Vascular - bleeding/haemotoma

Urological - leakage of urine/urinoma

30
Q

Prevention of anastamotic dehiscence?

A

Good technique

Good blood supply

No tension

31
Q

Causes of adhesions?

A

Inflammatory response

Ischaemia

32
Q

Presentation of adhesions?

A

Asymptomatic, e.g: to chest wall

Commonest cause of intestinal obstruction causing vomiting, pain, distension and constipation

33
Q

Prevention of adhesions?

A

No powder on gloves

Avoidance of infection

Laparoscopic surgery

Sodium hyaluronidate - decreased risk, part. in people who are having surgery for an adhesion complication

34
Q

Wound complications?

A

Infection - contamination from intestinal contents is usually the cause

Dehiscence

Incisional hernia - bowel contents can push out, below the skin

35
Q

Types of surgical wound infections?

A

Trauma is the main exogenous cause

Intestinal surgery (endogenous)

36
Q

Presentation of wound infection?

A 
Pyrexia (5-8 days)
Redness
Pain 
Swelling 
Discharge
37
Q

Prevention of wound infection?

A

Pre-op preparation (empty bowel to reduce potential of intestinal contents leaking out)

Skin cleansing and aseptic technique

Avoidance of contamination

Prophylactic antibiotics (a single dose before the surgery to increased tissue levels of antibiotic)

38
Q

Urinary complications of surgery?

A

Acute retention of urine, part. in males

UTIs (catheterisation)

Urethral stricture (prolonged catheterisation)

Acute renal failure

39
Q

Neurological complications of surgery?

A

Confusion

Stroke

Peripheral nerve lesions (avoid compression of nerves and position correctly) :
Ulnar nerve
Radial nerve
Sciatic nerve
Common peroneal nerve
40
Q

Causes of confusion?

A

Hypoxia:
Chest infection
PE
MI

Oversedation

Sepsis

Electrolyte imbalance

Stroke

Hyper or hyopglycaemia, part. in diabetics

Alcohol or tranquilliser withdrawal

41
Q

Presentation of confusion?

A

Disorientation:
Time
Place

Paranoia

Hallucinations

42
Q

Prevention of confusion?

A

Maintain oxygenation

Avoid dehydration

Avoid sepsis

Send home as soon as possible

43
Q

How to minimise complications and their effects?

A

Patient selection and preparation

Careful surgery

Constant vigilance

44
Q

What is Enhanced Recovery After Surgery (ERAS)?

A

Multimodal programme of enhanced care

To minimise post-operative complications and return patient to normality ASAP

Objectives are to promote:
Pain control
GI function
Mobility

45
Q

Components of the ERAS pathway?

A

Pre-operative
Peri-operative
Post-operative

46
Q

Pre-operative components of the ERAS pathway?

A

Pre-admission counselling

Fluid and CHO loading

No prolonged fasting

No/selective bowel preparation

Antibiotic prophylaxis

Thromboprophylaxis

No pre-medication

47
Q

Peri-operative components of the ERAS pathway?

A

Short acting anaesthetic agents

Mid-thoracic epidural anaesthesia/ analgesia

No drains

Avoidance of salt and water overload

Maintenance of normothermia (body warmer/warm intravenous fluids)

48
Q

Post-operative components of the ERAS pathway?

A

Mid-thoracic epidural anaesthesia/analgesia

No NG tubes

Prevention of N&V (nausea and vomiting)

Avoidance of salt and water overload

Early removal of catheter

Early oral nutrition

Non-opioid oral analgesia/ NSAIDs

Early mobilisation

Stimulation of gut motility

Audit of compliance and outcomes

Clinical (54 decks)

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