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GI > Surgical Complications > Flashcards

Surgical Complications Flashcards

1
Q

What cardiovascular complications can occur after surgery?

A

Haemorrhage
Myocardial infarction (MI)
Deep vein thrombosis (DVT)

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2
Q

HOw soon after surgery can a haemorrhage occur?

A
  • Immediate postoperative

OR Secondary
- e.g. due to Infection (5-10 days)

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3
Q

How do patients present with a post-operative haemorrhage?

A
  • Tachycardia
  • Hypotension
  • Oliguria
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4
Q

HOw is a post-op haemorrhage prevented?

A
  • Meticulous technique
  • Avoidance of sepsis
  • Correction of coagulation disorders
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5
Q

What increases a patient’s risk of post-op MI?

A
  • Severe angina

- Previous MI

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6
Q

MIs post-op are often silent. So how do they present?

A
  • Cardiac failure / cardiogenic shock

- Arrhythmias

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7
Q

HOw are post-op MIs prevented?

A
  • Delay surgery after MI
  • Avoidance of perioperative hypotension
  • Correction of ischaemic heart disease
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8
Q

What factors increase the likelihood of a patient having a DVT after surgery?

A
  • Age >40
  • Previous DVT
  • Major surgery
  • Obesity
  • Malignancy
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9
Q

Why does surgery cause patients to get a DVT?

A
  • Immobility during surgery

- Hypercoagulable state

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10
Q

How do patient’s normally present with a DVT?

A
  • Low grade fever (5-14 days)
  • Unilateral ankle swelling
  • Calf or thigh tenderness
  • Increased leg diameter
  • Shiny skin
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11
Q

What investigations can be used for DVT diagnosis?

A
  • D-dimer test
    (shows Degradation of fibrin)
  • Doppler Ultrasound
  • Venography
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12
Q

How are further DVTs prevented?

A
  • Compression stockings
  • Low-dose subcutaneous heparin
  • Early mobilisation
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13
Q

What respiratory complications can occur post-op?

A
  • Atelectasis (collapsed lung usually after pneumonia)
  • Pneumonia
  • Pulmonary embolus (PE)
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14
Q

Why can surgery predispose a patient to pneumonia?

A

Anaesthesia
- Increases secretions and inhibits cilia

Postop. pain
- Inhibits coughing as this causes more pain for pt

Aspiration of stomach contents may occur

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15
Q

How can patients present with post-op pneumonia?

A
  • Low grade fever (0-2 days)
  • High grade fever (4-10 days)
  • Dyspnoea
  • Productive cough
  • Confusion
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16
Q

How can post-op pneumonia be prevented as much as possible?

A
  • Stopping smoking
  • Adequate analgesia
  • Physiotherapy
17
Q

What increases the risk of a patient having a PE after surgery?

A 
Age > 40
Previous PE
Major surgery
Obesity
Malignancy
18
Q

How do patients normally present with a PE?

A
  • Tachypnoea
  • Dyspnoea
  • Confusion
  • Pleuritic pain
  • Haemoptysis
  • Cardiopulmonary arrest
19
Q

What investigations can be used to diagnose a PE?

A

V/Q scan

CT pulmonary angiogram

20
Q

HOw can we aim to prevent post-op PEs?

A
  • Compression stockings
  • Low-dose subcutaneous heparin
  • Early mobilisation
  • Anticoagulation in presence of DVT
21
Q

What GI complications can occur post operatively?

A
  • Ileus
  • Anastomotic dehiscence
  • Adhesions
22
Q

What is an ileus and what part of an operation can cause this?

A

Paralysis of intestinal motility

Caused by:

  • Handling of bowel
  • Peritonitis
  • Retroperitoneal injury
  • Immobilisation
  • Hypokalaemia
  • Drugs
23
Q

How do patients present with an ileus?

A
  • Vomiting
  • Abdominal distension
  • Dehydration
  • Silent abdomen
24
Q

How can we aim to prevent an ileus occurring post-operatively?

A
  • Minimal operative trauma
  • Laparoscopy
  • Avoidance of intra-abdominal sepsis
25
Q

Where can anastomotic breakdowns occur after an operation? What causes their breakdown?

A
  • Intestinal
  • Vascular
  • Urological

Caused by:

  • Poor technique
  • Poor blood supply
  • Tension on anastomosis
26
Q

How do patients present with an anastomotic dehiscense?

A

Intestinal

  • Peritionitis
  • Abscess
  • Ileus
  • Fistula

Vascular
- Bleeding / haematoma

Urological
- Leakage of urine / urinoma

27
Q

How can we prevent anastomotic dehiscense during surgery?

A
  • Good technique
  • Good blood supply
  • No tension
28
Q

What are adhesions and what causes them to appear post-op?

A

Fibrous tissue connections between:

  • bowel to bowel
  • bowel to abdominal wall/ other structures
  • Lung to chest wall

Caused by:

  • Inflammatory response
  • Ischaemia
29
Q

Patients with adhesions are normally asymptomatic. TRUE/FALSE?

A

TRUE

30
Q

What causes adhesions to make a patient symptomatic?

A
  • they may cause an Intestinal obstruction

=> Vomiting, Pain, Distension, Constipation

31
Q

HOw can we aim to prevent adhesions?

A
  • No powder on gloves
  • Avoidance of infection
  • Laparoscopic surgery
  • Sodium hyaluronidate
32
Q

What wound complications can occur after a patient has surgery?

A
  • Infection
  • Dehiscence
  • Hernia
33
Q

How do patient’s normally present with wound infection?

A
  • Pyrexia (5-8 days)
  • Redness
  • Pain
  • Swelling
  • Discharge
34
Q

HOw can wound infection be prevented?

A
  • Pre-op preparation
  • Skin cleansing
  • Aseptic technique
  • Avoidance of contamination
  • Prophylactic antibiotics
35
Q

What urinary complications can occur post-operatively?

A
  • Acute retention of urine
  • Urinary tract infection
  • Urethral stricture
  • Acute renal failure
36
Q

What neurological complications can occur post-operatively?

A
  • Confusion
  • Stroke
  • Peripheral nerve lesions
    (Ulnar/ radial/ sciatic/ common peroneal)
37
Q

What can cause patients to become confused post-op?

A
  • Hypoxia (pneumonia, PE, MI)
  • Oversedation
  • Sepsis
  • Electrolyte imbalance
  • Stroke
  • Hyper/hyopglycaemia
  • Alcohol or tranquilliser withdrawal
38
Q

How can we aim to prevent confusion in patients post-op?

A
  • Maintain oxygenation
  • Avoid dehydration
  • Avoid sepsis
  • Send home as soon as possible

GI (33 decks)

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