Week 7/8 - F - Surgery Complications - Cardiovascular, Respiratory, Gastrointestinal, Urinary, Neurological, Wound Flashcards
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?
Reactionary haemorrhage- immediately postoperative Secondary haemorrhage - due to infection (5-10 days later) Presents as Tachycardia, hypotension, oliguria
How can you prevent haemorrhage from occurring?
Meticulous aseptic technique Avoidance of sepsis Correction of coagulation disorders
What increases the risk of an MI post surgery? What is the presentation?
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
What can be done to minimize the risk of MI when carrying out a surgical intervention?
Delay surgery after MI Avoidance of perioperative hypotension Correction of ischaemic heart disease
What increases the risk of deep vein thrombosis when considering a surgical procedure?
Inceases risk with * Age>40 * Previous DVT * Major surgery * Obesity * Malignancy Due to immobility during surgery and being in a hypercoagulable state
How does a DVT following surgery often present?
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
How can the risk of DVTs following surgery be reduced?
* Education on frequent movement * Elevating the legs when lying supine * No prolonged sitting * Compression stockings * Low dose subcut heparin * Early mobilisation
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?
Atelectasis is a common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty.
What causes atelectasis? How can this potentially cause infection?
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
When should atelectasia be suspected? How is it managaed?
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
How does pneumonia present?
Low grade fever (0-2 days) High grade fever (4-10 days) Dyspnoea Productive cough Confusion
What are the risk factors for pulmonary embolism following a surgery? What is it caused by?
Increased risk with: Age > 40 Previous PE Major surgery Obesity Malignancy Caused by: DVT
How does a PE present?
Tachypnoea Dyspnoea Confusion Pleuritic pain Haemoptysis Cardiopulmonary arrest Prevention is the same as for DVT
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?
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
How does paralytic ileus present? What is the treatment?
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
How can paralytic ileus be prevented?
Minimal operative trauma Laparoscopy Avoidance of intra-abdominal sepsis
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?
It is a breakdown of the anastamosis formed in the surgery it is caused by * Poor technique * Poor blood supply * Tension on the anastamosis
How does anastamotic dehiscence present? * Intestinal presentation * Vascular presentation * Urological presentation
Intestinal Peritionitis Abscess Ileus Fistula Vascular Bleeding / haematoma Urological Leakage of urine / urinoma
How can anastamotic dehiscence be prevented?
It can be prevented by * Good technique * Good blood supply * No tension
Adhesions are a common complication of GI tissue What causes the adhesions? What can the adhesions form between?
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
What is the presentation of abdominal adhesions?
Intestinal obstruction Vomiting Pain Distension Constipation
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
Acute retention of urine Urinary tract infection Urethral stricture Acute renal failure
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?
* Hypoxia - chest infection, PE, MI * Oversedation * Sepsis * Electrolyte imbalance * Stroke * Hyper or hypoglycaemia
How can confusion post-surgery be prevented?
Maintain oxygenation Avoid dehydration Avoid sepsis Send home as soon as possible!
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?
* Pyrexia * Redness * Pain * Swelling * Discharge
How can wound infection be prevented?
Pre-op preparation Skin cleansing Aseptic technique Avoidance of contamination Prophylactic antibiotics
