Week 7/8 - F - Surgery Complications - Cardiovascular, Respiratory, Gastrointestinal, Urinary, Neurological, Wound

Question 1

This deck of cards will take a systematic approach to the complications that can arise due to a surgical procedure

• Cardiovascular
• Respiratory
• Gastrointestinal
• Urinary
• Neurological
• Wound
• Cardiovascular - haemorrhage, MI, DVT

What are the two types of haemorrhage that can arise due to a surgical procedure? How does it present?

Answer 1

Reactionary haemorrhage- immediately postoperative Secondary haemorrhage - due to infection (5-10 days later) Presents as Tachycardia, hypotension, oliguria

Question 2

How can you prevent haemorrhage from occurring?

Answer 2

Meticulous aseptic technique Avoidance of sepsis Correction of coagulation disorders

Question 3

What increases the risk of an MI post surgery? What is the presentation?

Answer 3

Risk increased win patients with Severe angina Previous MI Presentation is often silent * Can present as cardiac failure / cardiogenic shock * Or arrythmias * Of course can present as classical MI

Question 4

What can be done to minimize the risk of MI when carrying out a surgical intervention?

Answer 4

Delay surgery after MI Avoidance of perioperative hypotension Correction of ischaemic heart disease

Question 5

What increases the risk of deep vein thrombosis when considering a surgical procedure?

Answer 5

Inceases risk with * Age>40 * Previous DVT * Major surgery * Obesity * Malignancy Due to immobility during surgery and being in a hypercoagulable state

Question 6

How does a DVT following surgery often present?

Answer 6

Presents with * Low grade fever * Unilateral ankle/calf swelling * Calf or thigh tenderness * Increased leg diameter >3cm than other leg 10cm below tibal tuberosity * Shiny skin

Question 7

How can the risk of DVTs following surgery be reduced?

Answer 7

* Education on frequent movement * Elevating the legs when lying supine * No prolonged sitting * Compression stockings * Low dose subcut heparin * Early mobilisation

Question 8

This deck of cards will take a systematic approach to the complications that can arise due to a surgical procedure * Respiratory * Gastrointestinal * Urinary * Neurological * Wound Respiratory - Atelactasis, pneumonia, pulmonary embolus * What is atelactasis and what causes it?

Answer 8

Atelectasis is a common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty.

Question 9

What causes atelectasis? How can this potentially cause infection?

Answer 9

Anaesthesia increases secretions and inhibits cilia The bronchial secretions obstruct the lung airway leading to potential collapse Post-op pain inhibits coughing leading to potential aspiration of stomach contents causing pneumonia

Question 10

When should atelectasia be suspected? How is it managaed?

Answer 10

Features it should be suspected in the presentation of dyspnoea and hypoxaemia around 72 hours postoperatively Management positioning the patient upright chest physiotherapy: breathing exercises

Question 11

How does pneumonia present?

Answer 11

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

Question 12

What are the risk factors for pulmonary embolism following a surgery? What is it caused by?

Answer 12

Increased risk with: Age > 40 Previous PE Major surgery Obesity Malignancy Caused by: DVT

Question 13

How does a PE present?

Answer 13

Tachypnoea Dyspnoea Confusion Pleuritic pain Haemoptysis Cardiopulmonary arrest Prevention is the same as for DVT

Question 14

This deck of cards will take a systematic approach to the complications that can arise due to a surgical procedure * Gastrointestinal * Urinary * Neurological * Wound Gastrointestinal - ileus, anastomatoic dehiscence, adhesions * What type of ileus typically can occur as a complication of surgeries? * Which surgeries especially?

Answer 14

Paralytic ileus It is the disruption of normal propulsive activity of the GI tract, due to failure of peristalsis Paralytic ileus is a common complication after surgery involving the bowel, especially surgeries involving handling of the bowel Paralytic ileus can also occur in association with chest infections, myocardial infarction, stroke and acute kidney injury and electrolyte abnormalities

Question 15

How does paralytic ileus present? What is the treatment?

Answer 15

SIgns and symptoms of paralytic ileus are similar to bowel obstruction eg abdo distension, N&V, no flatus or bowel movements * - however pain, and high pitched bowel sounds are less common Treatment is - drip and suck while waiting for restoration of peristalsis

Question 16

How can paralytic ileus be prevented?

Answer 16

Minimal operative trauma Laparoscopy Avoidance of intra-abdominal sepsis

Question 17

Anastomotic dehiscence is perhaps the complication that is feared most by colorectal surgeons. It is associated with substantial morbidity and mortality What is anastamostic dehiscence? What is it caused by?

Answer 17

It is a breakdown of the anastamosis formed in the surgery it is caused by * Poor technique * Poor blood supply * Tension on the anastamosis

Question 18

How does anastamotic dehiscence present? * Intestinal presentation * Vascular presentation * Urological presentation

Answer 18

Intestinal Peritionitis Abscess Ileus Fistula Vascular Bleeding / haematoma Urological Leakage of urine / urinoma

Question 19

How can anastamotic dehiscence be prevented?

Answer 19

It can be prevented by * Good technique * Good blood supply * No tension

Question 20

Adhesions are a common complication of GI tissue What causes the adhesions? What can the adhesions form between?

Answer 20

Adhesions are due to increased fibrin during surgery causing the development of increased fibrous tissue Bowel to bowel Bowel to abdominal wall and other structures Lung to chest wall

Question 21

What is the presentation of abdominal adhesions?

Answer 21

Intestinal obstruction Vomiting Pain Distension Constipation

Question 22

This deck of cards will take a systematic approach to the complications that can arise due to a surgical procedure * Urinary * Neurological * Wound What are different urinary complications of surgery? - complications of urinary surgery

Answer 22

Acute retention of urine Urinary tract infection Urethral stricture Acute renal failure

Question 23

This deck of cards will take a systematic approach to the complications that can arise due to a surgical procedure * Neurological * Wound Neurological - confusion, stroke, peripheral nerve lesions What can cause confusion following surgery?

Answer 23

* Hypoxia - chest infection, PE, MI * Oversedation * Sepsis * Electrolyte imbalance * Stroke * Hyper or hypoglycaemia

Question 24

How can confusion post-surgery be prevented?

Answer 24

Maintain oxygenation Avoid dehydration Avoid sepsis Send home as soon as possible!

Question 25

This deck of cards will take a systematic approach to the complications that can arise due to a surgical procedure * Wound Wound - infection, dehiscence, hernia How does wound infection present?

Answer 25

* Pyrexia * Redness * Pain * Swelling * Discharge

Question 26

How can wound infection be prevented?

Answer 26

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