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COMAT: Surgery > Surgical Complications > Flashcards

Surgical Complications Flashcards

1
Q

what is atelectasis?

A

collapse of the alveoli

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2
Q

what are the signs of atelectasis?

A

fever, decreased breath sounds with rales, tachypnea, tachycardia, and increased density on CXR

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3
Q

what is atelectasis claim to fame?

A

most common cause of fever during PODs 1 and 2

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4
Q

what prophylactic measures can be taken to prevent atelectasis?

A

preoperative smoking cessation, incentive spirometry, good pain control

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5
Q

what is the treatment of atelectasis?

A

postoperative incentive spirometry, deep breathing, coughing, early ambulation, NT suctioning, and chest PT

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6
Q

what is postoperative respiratory failure?

A

respiratory impairment with increased respiratory rate, shortness of breath, dyspnea

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7
Q

what is the treatment of postoperative respiratory failure?

A

supplemental O2, chest PT; suctioning, intubation, and ventilation of necessary

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8
Q

what is the initial workup of postoperative respiratory failure

A

ABG, CXR, EKG, pulse oximetry, and auscultation

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9
Q

what are the indications for intubation and ventilation

A

cannot protect airway, excessive work of breathing, progressive hypoxemia, progressive acidosis

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10
Q

what is the treatment of postoperative wheezing?

A

albuterol nebulizer

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11
Q

why may it be dangerous to give a patient with chronic COPD supplemental oxygen?

A

this patient uses relative hypoxia for respiratory drive and supplemental O2 may remove this drive

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12
Q

what is a pulmonary embolism (PE)?

A

DVT that embolisms to the pulmonary arterial system

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13
Q

what is DVT?

A

deep vein thrombosis - a clot forming in the pelvic or Lower extremity veins

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14
Q

what are the sign/symptoms of DVT

A

lower extremity pain, swelling, tenderness, Homan’s sign, PE

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15
Q

what is Homan’s sign?

A

calf pain with dorsiflexion of the foot classically seen with DVT

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16
Q

what test is used to evaluate for DVT?

A

duplex ultrasonography

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17
Q

what is Virchow’s triad?

A

stasis
endothelial injury
hypercoaguable state

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18
Q

what are the signs/symptoms of PE?

A

shortness of breath, tachypnea, hypotension, CP, occasional fever, loud pulmonic component of S2, hemoptysis with pulmonary infarction

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19
Q

what are the associated lab findings with PE

A

ABG - decreased pO2 and pCO2 from hyperventilation

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20
Q

what diagnostic test is indicated for PE

A

CT angiogram

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21
Q

what are the X-ray signs associated with PE

A
  • Westermark’s sign = wedge-shaped area of decreased pulmonary vasculature resulting in hyperlucency
  • opacity with base at pleural edge from pulmonary infarction
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22
Q

what are the EKG findings associated with PE

A

most are abnormal
classic finding is:
- cor pulmonale = S1Q3T3 RBBB and right-axis deviation
EKG most commonly shows flipped T waves or ST depression

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23
Q

what is a ‘saddle’ embolus

A

PE that ‘straddles’ the pulmonary artery and is in the lumen of both the right and left pulmonary arteries

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24
Q

what is the treatment of PE if the patient is stable

A

anticoagulation - heparin followed by LT warfarin or Greenfield filter

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25
what is an IVC filter
metallic filter placed into IVC via jugular vein to catch emboli prior to lodging in the pulmonary artery
26
when is an IVC filter indicated
if anticoagulation is contraindicated or patient has further PE on adequate anticoagulation or is high risk
27
what is the treatment of PE if the patient is unstable
consider thrombolytic therapy consult thoracic surgeon for possible Trendelenberg operation' consider catheter suction embolectomy
28
what is the Trendelenberg operation
pulmonary artery embolectomy
29
what is a 'retrievable' IVC filter
IVC filter that can be removed
30
what is aspiration pneumonia
pneumonia following aspiration of vomitus
31
what are the signs/symptoms of aspiration pneumonia
respiratory failure, CP, increased sputum production, fever, cough, mental status changes, tachycardia, cyanosis, infiltrate on CXR
32
what is the treatment of aspiration pneumonia?
bronchoscopy, abx if pneumonia develops, intubation if respiratory failure occurs, ventilation with PEEP if ARDS occurs
33
what is Mendelson's syndrome
chemical pneumonitis secondary to aspiration of stomach contents
34
are prophylactic abx indicated for aspiration pneumonitis
NO
35
what are the risk factors for gastric dilatation?
abdominal surgery, gastric outlet obstruction, splenectomy, narcotics
36
what are the signs/symptoms of gastric dilatation?
abdominal distention, hiccups, electrolyte abnormalities, nausea
37
what is the treatment of gastric dilatation?
NGT decompression
38
what do you do if you have a patient with high NGT output?
check high abdominal X-ray and if the NGT is in duodenum, pull back the NGT into the stomach
39
what is postoperative pancreatitis?
pancreatitis resulting from manipulation of the pancreas during surgery or low blood flow during the procedure, gallstones, hypercalcemia, medications, idiopathic
40
what lab tests are performed for postoperative pancreatitis?
amylase and lipase
41
what is the initial treatment for postoperative pancreatitis?
same as for other causes of pancreatitis | - NPO, aggressive fluid resuscitation, +/- NGT PRN
42
what are the postop causes of constipation?
narcotics, immobility
43
what is the treatment of constipation?
OBR
44
what is OBR?
ortho bowel routine | - docusate sodium, dicacodyl suppository if no BM occurs, fleet enema if suppository ineff
45
what is short bowel syndrome?
malabsorption and diarrhea resulting from extensive bowel resection
46
what is the initial treatment of short bowel syndrome?
TPN early, followed by many small meals chronically
47
what is blind loop syndrome?
bacterial overgrowth in the small intestine
48
what are the causes of blind loop syndrome?
anything that disrupts the normal flow of intestinal contents (causes stasis)
49
what are the surgical causes of vitamin B12 deficiency?
blind loop syndrome, gastrectomy (decreased secretion of intrinsic factor), and excision of the terminal ileum (site of B12 absorption)
50
what is postvagotomy diarrhea?
diarrhea after a truncal vagotomy
51
what is the cause of postvagotomy diarrhea?
a rapid transport of bile salts to the colon results in osmotic inhibition of water absorption in the colon, leading to diarrhea
52
what is dumping syndrome?
delivery of hyper osmotic chyme 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
with what conditions is dumping syndrome associated?
any procedure that bypasses the pylorus or compromises its function
54
what are the signs/symptoms of dumping syndrome
postprandial diaphoresis, tachycardia, abdominal pain/distention, emesis, increased flatus, dizziness, weakness
55
what is the medical treatment of dumping syndrome
small, multiple, low-fat/carbohydrate meals that are high in protein content
56
what is the surgical treatment of dumping syndrome
conversion to Roux-en-Y
57
what is diabetic ketoacidosis (DKA)?
deficiency of body insulin resulting in hyperglycemia, formation of ketoacids, osmotic diuresis, and metabolic acidosis
58
what are the signs of DKA
polyuria, tachypnea, dehydration, confusion, abdominal pain
59
what is the treatment for DKA
insulin drip, IVF rehydration, K+ supplementation, +/- bicarbonate IV
60
what electrolyte must be monitored closely in DKA
potassium and HYPOkalemia | - correction of acidosis and GLC/insulin drive K+ into cells and are treatment for HYPERkalemia
61
what must you rule out in a diabetic with DKA
infection
62
what is Addisonian crisis?
acute adrenal insufficiency in the face of a stressor
63
what is the cause of Addisonian crisis?
postoperatively, inadequate cortisol release usually results from steroid administration in the past year
64
what are the signs/symptoms of Addisonian crisis?
tachycardia, nausea, vomiting, diarrhea, abdominal pain, +/- fever, progressive lethargy, hypotension, eventual hypovolemic shock
65
what is Addisonian crisis' clinical claim to fame?
tachycardia and hypotension refractory to IVF and pressors
66
which lab values are classic for Addisonian crisis?
``` hyponatremia hyperkalemia (secondary to decreased aldosterone) ```
67
what is the treatment for Addisonian crisis?
IVFs (D5NS), hydrocortisone IV, fludrocortison PO
68
what is fludrocortisone?
mineralocorticoid replacement (aldosterone)
69
what is SIADH?
syndrome of inappropriate antidiuretic hormone secretion
70
what does ADH do?
ADH increases NaCl and H2O resorption in the kidney, increase intravascular volume - released from posterior pituitary
71
what are the causes of SIADH?
mainly lung/CNS
72
what are the associated lab findings with SIADH?
hyponatremia hypochloremia low serum osmolality increased urine osmolality
73
how can the serum sodium level in SIADH be remembered
Sodium Is Always Down Here
74
what is the treatment of SIADH
treat the primary cause and restrict fluid intake
75
what is diabetes insipidis (DI)
failure of ADH renal fluid conservation resulting in dilute urine in large amounts
76
what is the source of ADH
posterior pituitary
77
what are the two major types of DI
central (neurogenic) - decreased production of ADH nephrogenic - decreased ADH effect on kidney
78
what are the classic causes of central DI
brain injury, tumor, surgery, and infection
79
what are the classic causes of nephrogenic DI
Amphotericin B, hypercalcemia, and chronic kidney infection
80
what lab values are associated with DI
hypernatremia decreased urine sodium decreased urine osmolality increased serum osmolality
81
what is the treatment of DI
fluid replacement follow Na+ levels and urine output central DI warrants vasopressin nephrogenic DI may respond to thiazide diuretics
82
what is DIC
activation of the coagulation cascade leading to thrombosis and consumption of clotting factors and platelets and activation of fibrinolytic system (fibrinolysis), resulting in bleeding
83
what is the treatment of DIC
removal of the cause, otherwise supportive: IVF, O2, platelets, FFP, cryoprecipitate, use of heparin is indicated in cases that are predominantly thrombotic with antithrombin III supplementation as needed
84
what is abdominal compartment syndrome ?
increased intra-abdominal pressure usually seen after laparotomy or after massive IVF resuscitation (burn)
85
what are the signs/symptoms of abdominal compartment syndrome?
tight distended abdomen, decreased urine output, increased airway pressure, increased intra-abdominal pressure
86
how do you measure intra-abdominal pressure?
read intrabladder pressure
87
what is the normal intra-abdominal pressure?
<15mmHg
88
what intra-abdominal pressure indicates need for treatment?
>25mmHg
89
what is the treatment of abdominal compartment syndrome?
release of pressure by decompressive laparotomy (leaving fascia open)

COMAT: Surgery (17 decks)

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