wk 8 6 Surgery and Complications Flashcards
3 likely carvdiovascular complications postop
haemorrhage
MI
DVT
haemorrhage can be classified as reactionary or secondary, outline each
reactionary - immediately postop
secondary - infection (5-10d)
how does a haemorrhage present 4
overt
tachycardia
hypotension
oliguria (low urine output)
3 ways a haemorrhage can be prevented
perfect technique
sepsis advoidance
correction of coagulation disorders
2 things which increase risk of MI
severe angina
previous MI
how does MI postop present 3
often silent
cardiac failure / cardiogenic shock
arrhytmias
2 things which help prevent MI postop
avoidance of perioperative hypotensioin
correction of ischaemic heart disease
5 factors which increase DVT postop
age >40 previous DVT majory surgery Obesity Malignancy
immobility and ______ during surgery cause DVT
hypercoagulable state
DVT postop presentation
Low grade fever (5-14d) unilateral ankle swelling Calf/thigh tenderness Incr leg diameter Shiny skin
3 ways DVT should be investigated
D-dimer test
Doppler Ultrasound
Venography
3 ways DVT can be prevented postop
compression stockings
Low-dose subcutaneous heparin
Early mobilisation
3 respiratory complications postop
Atelectasis (complete/partial lung collapse)
Pneumonia
PE
The collapse of lung tissue in atelectasis or pneumonia can be due to anesthesia, postop pain or aspiration, outline each
anesthesia - incr secretion and inhibits cilia
postop pain - inhibits coughing
aspiration - stomach contents
5 ways a chest infection could present
low grade fever (0-2d) high grade fever (4-10d) Dyspnoea Productive cough Confusion
3 ways chest infections could be prevented postop
stopping smoking
adequate analgesia
physiotherapy
5 ways PE risk is increased postop
Age >40 previous PE major surgery obesity malignancy
cause of PE
DVT
presentation of postop PE 6
tachypnoea Dyspnoea Confusion Pleuritic pain Haemoptysis Cardiopulmonary arrest
investigations for postop PE
abnormal V/Q scan
CT pulmonary angiogram
PE prevention 4
compression stockings (comes from DVT)
low-dose subcutaneous heparin
early mobilisation
Anticoagulation in presence of DVT
3 GI postop problems
Ileus (peristalstic paralysis)
Anastomotic dehiscence (colorectal resection bursting at stitches)
Adhesions
6 ways an ileus could occur postop
handling of bowel peritonitis retroperitoneal injury immobilisation hypokalaemia drugs
ileus postop presentation 4
vomiting
ab distension
dehydration
silent abdomen
3 ways an ileus can be prevented
minimal operative trauma
laparoscopy
avoidance of intra-abdominal sepsis
anastomotic dehiscence is the breakdown of anastomosis, what 3 areas could this occur at
intestinal
vascular
urological
3 causes of anastomotic dehiscence
poor technique
poor blood supply
tension of anastomosis
outline how anastomotic dehiscence could be presented if intestinal, vascular or urological
intestinal
- peritoneal
- abscess
- ileus
- fistula
vascular
- bleeding/ haematoma
urological
- leakage of urine / urinoma
3 ways anastomotic dehiscence could be prevented
good technique
good blood supply
no tension
what is adhesions in operation
fibrin develops, leading to fibrous tissue
outline 3 possible adhesions
bowel - bowel
bowel - ab wall/other structures
lung - chest wall
2 ways adhesions occur
inflammatory response
ischaemia
t/f adhesions to chest wall are asymptomatic
true
4 key things to loook out for in intestinal obstructio n
vomiting
pain
distension
constipation
4 ways adhesions can be prevented
no powder on gloves
avoidance of infection
laparoscopic surgery
sodium hyaluronidate (natural tissue lube)
3 wound complications
infection
dehiscence
hernia
wound infection can be either exogenous or endogenous, explain each
exogenous - trauma
endogenous - intestinal surgery
presentation of wound infection 5
pyrexia (5-8d) redness pain swelling dischargw
5 ways wound infections can be prevented
pre-op preparation
skin cleansing
aseptic technique
avoidance of contamination prophylactic antibiotics
4 complications in urinary
acute urinary retention
UTI
urethral stricture
acute renal failure
3 neurological complications postop
confusion
stroke
peripheral nerve lesions (ulnar/radial/sciatic/common peroneal nerves)
how can confusion occur 7
hypoxia (Chest infection/PE/MI) oversedation sepsis electrolyte imbalance stroke hyper/hypoglycaemia alcohol/transquiliser withdrawal
3 ways confusion can present
disorientation
paranoia
hallucinations
4 ways confusion can be prevented
maintain oxygenation
avoid dehydration
avoid sepsis
send home asap
what should be avoided pre-op
no prolonged fasting
selective bowel preparation
no premedication
what should be avoided peri-op
salt and water overload changes in body temp
drains
long acting anaesthetic agents
postop should avoid
salt and water overload NG tube Catheters staying in for long delay in nutrition immobilisation
