Complications of abdominal surgery

education material

1. Complications of surgery
A. Thangamani ramalingam
PT, MSc(PSY), MIAP

2. complications
Respiratory
Circulatory
Wound related
Joint mobility/muscle weakness
Postural deformity
others

3. Atelectasis
Increased temperature, pulse &
respiratory rate
Flushed/feverish patient
Tightness/discomfort of the affected
side
Poor chest expansion
X-ray reveals collapse of lung

4. In first 48 hrs after surgery
Painful /impaired respiration
Reflex inhibition of diaphragmatic
movement due to pain &anaesthesia
Difficulty in coughing
Weak abdominal muscles
Cough reflex inhibition due to
analgesia
Accumulation of secretions

5. Pneumonia
Aspiration pneumonia

6. hemodynamics
Decreases-thrombosis, ischemia
&infarction
Increases- hemorrhage, edema
&hyperemia

7. Thrombosis/Greek-clot
Increased temp
Tender/swollen calf
Red/shiny skin
Homan’s test positive
Engorged veins/edema
Cord like veins
Pain along the course of the vein

8. Deep vein thrombosis

9. Risk of DVT may begin
during,in24-48hrs or late
as 3 months of surgery

10. Homans' sign is a sign of
deep vein thrombosis (DVT). A
positive sign is present when there is
pain in the calf or popliteal region
with examiner's abrupt dorsiflexion of
the patient's foot at the ankle while
the knee is flexed to 90 degrees.

11. Pratt's sign is an indication of
femoral deep vein thrombosis. It is
seen as the presence of dilated
pretibial veins in the affected leg,
which remain dilated on raising the
leg.
The sign was described by American
surgeon Gerald H. Pratt of
St. Vincent's Hospital in 1949

12. Wells score or criteria: (Possible score -2 to 9)
Active cancer (treatment within last 6 months or
palliative) +1 point
Calf swelling >3 cm compared to other calf
(measured 10 cm below tibial tuberosity) +1 point
Collateral superficial veins (non-varicose) +1 point
Pitting edema (confined to symptomatic leg) +1
point
Previous documented DVT +1 point.
Swelling of entire leg +1 point
Localized pain along distribution of deep venous system
+1 point
Paralysis, paresis, or recent cast immobilization of lower
extremities +1 point
Recently bedridden > 3 days, or major surgery requiring
regional or general anesthetic in past 4 weeks +1
point
Alternative diagnosis at least as likely -2 points

13. Interpretation:
Score of 2 or higher — deep vein
thrombosis is likely. Consider
imaging the leg veins.
Score of less than 2 — deep vein
thrombosis is unlikely. Consider
blood test such as d-dimer test to
further rule out deep vein
thrombosis.

14. DVT complications(long term)
Night pain
Venous ulceration
edema

15. Diagnostic tests
Duplex ultra sound
Venography
Impedance plethysmography
MRI
D-dimer blood test

16. Prevention of DVT
Heparin
Warfarin
Aspirin
Dextran
Compression devices

17. embolism
Greek-wedge/stopper

18. Pulmonary embolism
Increased temperature, pulse & respiratory
rate
Changes in patient color
Severe chest pain/dysnea
Pleurisy/blood stained sputum
Cough, diaphoresis, apprehension
Fever
Bulging neck veins
Altered mental status

19. Clinical findings of PE
ST segment depression or T wave
inversion
Right axis deviation
Right bundle branch block

20. infarction
Latin-stuffed

21.  Limb infarction is an infarction of an
arm or leg. Causes include
arterial embolisms and skeletal
muscle infarction as a rare
complication of long standing, poorly
controlleddiabetes mellitus. A major
presentation is painful thigh or leg
swelling.

22. oedema
General
Cardiac
Renal
Malnutrition/star
vation
Local
Inflammatory
Obstructive
Paralytic
Gravitational
hereditary

23. causes
increased hydrostatic pressure;
reduced oncotic pressure within blood vessels;
increased tissue oncotic pressure;
increased blood vessel wall permeability e.g. 
inflammation;
obstruction of fluid clearance via the 
lymphatic system;
changes in the water retaining properties of the 
tissues themselves. Raised hydrostatic pressure often 
reflects retention of water and sodium by the kidney.

24. mechanism
Generation of interstitial fluid is regulated by the 
forces of the Starling equation. Hydrostatic pressure 
within blood vessels tends to cause water to filter out 
into the tissue. This leads to a difference in protein 
concentration between blood plasma and tissue. As a 
result the oncotic pressure of the higher level of 
protein in the plasma tends to suck water back into 
the blood vessels from the tissue. Starling's equation 
states that the rate of leakage of fluid is determined 
by the difference between the two forces and also by 
the permeability of the vessel wall to water, which 
determines the rate of flow for a given force 
imbalance. 

25. types
Pit oedema-watery low protein 
content
Inflammatory oedema-thick fluid with 
high protein content

28. hemorrhage
Revealed and concealed hemorrhage
Primary/reactionary/secondary 
hemorrhage
Surgical/non surgical hemorrhage
Altered pulse & resp rate

29. Hemorrhagic shock
Class 1-    <15%
Class 2-    15-30%
Class 3-    30-40%
Class 4-     <40%

30. Blood transfusion
Whole blood
Packed red cells
Fresh-frozen 
plasma
Cryoprecipitate
Platelets
Prothrombin 
complex 
concentrates
Autologus blood
Indication
Acute loss
Anemia <6g/dl

31. Pressure sore
Stages
Blanching
Hyperemia
Pressure area
sore
Grades
1to4

32. Sepsis

 (from Gr. the state of putrefaction or 
decay) is a potentially deadly medical
 condition that is characterized by a whole-
body inflammatory state (called a 
systemic inflammatory response syndrome
 or SIRS) and the presence of a known or 
suspected infection. The body may develop 
this inflammatory response by the 
immune system to microbes in the blood, 
urine, lungs, skin, or other tissues. 

33. Increased temp,resp.rate &heart rate
Severe sepsis is the systemic 
inflammatory response, plus 
infection, plus the presence of organ 
dysfunction.
 A lay term for sepsis is blood 
poisoning, also used to describe 
septicemia. 

34. shock
The typical signs of shock are low blood pressure,
a rapid heartbeat and signs of poor end-
organ perfusion or "decompensation" (such as low
urine output, confusion or loss of consciousness
Hypovolaemic shock
Cardiogenic shock
Distributive shock includes infectious,
anaphylactic and neurogenic causes

35. General muscle weakness
Loss of mobility

36. Hiccough
Vomiting
Urine retention
Abdominal distension
Peritonitis
Burst abdomen
Paralytic ileus
Renal failure

37. Urinary calculai
UTI
Incontinence
Insomnia/depression
Loss of appetite/weight
Constipation
Indigestion
Less efficient immune system
Sluggish liver &renal function
Postural hypotension/supine hypotensive syndrome

38. Wound infection
Postoperative wound infection is
an infection in the tissues of the
incision and operative area. It can
occur from 1 day to many years after
an operation but commonly occurs
between the fifth and tenth days after
surgery.

39. pain, tenderness, localized swelling,
redness, or heat.
 microbes flourishing in the surgical
site because of poor preoperative
preparation, wound contamination,
poor antibiotic selection, or the
inability of an immuno compromised
patient to fight off infection.

40. Factors increasing an individual's risk
include malnutrition, decreased blood
volume, lengthy preoperative stay,
hypothermia, poor tissue
perfusion, diabetes, and the use of
immunosuppressant's such as steroids
Advanced age and obesity increase an
individual's risk of having infection at the
surgical site

41. Wound infection can cause separation
of the wound layers, incisional
hernias, abscesses, and tissue
destruction (gangrene or necrotizing
fasciitis), which can result in physical
and/or functional deformity. Bacteria
from the infection can spread,
causing an overwhelming, life-
threatening, systemic infection
(sepsis).

42. Kypho-scoliosis

43. thank you