Complications

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• Complications
• Side Effects
• Sequela
• Results
• Outcome
• Prognosis

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????Chapter Complication?Schwartz? ?
Principles of Surgery?
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General Complications

• Wound Complications ??
  1.
• Postoperative Parotiditis ( ?? ) ???
• Postoperative Respiratory Complications ??
  3.
• Cardiac / Circulatory Complications ?? 4.
• Diabetes Mellitus
• Fat Embolism syndrome
  ???????
• Psychiatric Complications (?? )
• Complications of Gastrointestinal Surgery ??
  2.

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Wound Complications ?????

• Wound Infection ???? ??
• Wound Hemorrhage, ??
• Hematoma, ??
• Seroma
  ????
• Wound Dehiscence ??

• Intra-abdominal Hematoma and Abscess

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• ????
• FClean ... Partl contaminated ... Contad
  wound
• ????
• FAge, Nutrition, Immunity, BW,..
• FDisease, Defense, Deficiency.
• ?????
• F Hospital environment. FPersonnel Med.,
  Guest or Trader, .. F Med. Instrument
  article..
• ????? F FB, Infection,
  Contamination..

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Hematoma and Abscess
Retro-gastric ?
Subhepatic ?
Subphrenic
?

• and Rectal pouch, Caecal fossa ...

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Wound Incision -- Wound Complications -- Wound
Dehiscence
Upper median incision Para-median
incision Para-rectal incision McBurney incision
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Gastrointestinal Surgery

• Gastrointestinal Anastomosis
• After total Gastrectomy
• After subtotal Gastrectomy
• After proximal cardiectomy
• After antrectomy

• Entero-enterostomy
• Jejuno-colostomy
• Ileo-colostomy, Ceco-ileostomy
• Coco-colostomy
• Appendectomy

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Complications of Gastrointestinal Surgery

• Gastrointestinal Anastomosis
• Total Gastrectomy
• Subtotal Gastrectomy
• Billroth I Gastro-duodenostomy
• Billroth II Gastro-jejunostomy
• Billroth III Inadvert Gastroileostomy

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Total Gastrectomy
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Cardiectomy x-1 Subtotal Gastrectomy
x-2
Resection x-1
Resection x-2
Antrectomy x-3
Resection x-3
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Complications of Gastrointestinal
Surgery????????

• Postoperative Complications ??????
• Suture disrupt duodenal stump /
  gastrojejunostomy.
• Peritonitis ileus.
  ??????
• Retrogastric hematoma / abscess.
  ????/??
• Subphrenic / subhepatic abscess.
  ??/????
• Intra- or extraluminal bleeding.
  ???/???
• Pancreatitis, pancreatic necrosis.
  ???/????

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Hematoma and Abscess
Retro-gastric ?
Subhepatic ?
Subphrenic
?

• and Rectal pouch, Caecal fossa ...

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Complications of Gastrointestinal Surgery

• Complications of Gastrointestinal Surgery

• Vascular Complications ?????
• Hemorrhage ??
• Gangrene ??

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• Complications of Gastrointestinal Surgery

• Mechanical Problem
• Stoma Obstruction ????????
• Afferent ( Blind ) Loop Syndrome
• ???????
• Intestinal Obstruction ???
• Inadvert Gastroileostomy ????????

Anastomotic Leakage ??????
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• Complications of Gastrointestinal Surgery

• External Fistula and Stoma Complications
  ???????????
• Fistula ??
• External Stoma Complications
• ??????????

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General Complications

• ?????????
• Postoperative Respiratory Complications
• Atelectasis ???/???
• Respiratory Failure ????
• Pulmonary edema ???
• ( Pulmonary congestion )

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• General Complications

• Atelectasis
• Lobar Atelectasis
• Segmental Atelectasis
• Plate like Atelectasis
• Reduced Alveolar Surface Tension
• Bronchial Secretion Obstruction
• Fever, Rapid RR / HR, Collapse / Purification

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• General Complications

• Treatment of Atelectasis
• Patent Air Way
• Enforced Respiration
• Ventilator Support
• Return to Normal Surfactant
• Clear the Bronchial Passage
• Warm Moist Inhalation
• Complete Respiratory Care
• Fluid supply Antibiotics

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• General Complications

Respiratory Failure ????

• Definition
• PaO2 lt Predicted normal
• PaCO2 gt 50 mmHg metabolic alkalosis

• Pathophysiology
• Hypoventilation
• Diffusion defect
• Abnormal V/Q ratio
• Shunting
• Reduction in Cardiac Output
• Hb/Dissociation Curve Alteration

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Pulmonary Edema ( Pulmonary Congestion )

• General Complications

??????????,???Pulmonary Congestion
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Treatment of Pulmonary Edema

• General Complications

????????,???Pulmonary Edema
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• General Complications

Respiratory Failure ????
Indication for Respiratory Support

• FiO2
• Qs/Qt
• A-aDO2
• VD/VT
• PEEP
• CPAP
• IPPB
• IMV

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• General Complications

Complications Following Respiratory Support

• Endotracheal Intubation /Tracheostomy
• Airway Aphonia
• Wound Bleeding/Infection
• Cuff Pressure - Erosion/Bleeding
• /Stricture/ Granuloma
• Mechanical Ventilator
• PEEP Pneumothorax
• Prolonged Ventilator Use / Oxygen Intoxication
• Lung Edema / Weaning Failure

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• General Complications

• Cardiac Complications ??????
• Arrhythmias
  ????
• Myocardial Infarction ????

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• General Complications

Cardiac Complications -- Arrhythmias
Old age gt 60y , Arteriorsclerosis, Heart Diseas,
Hypertension Anesthesia ( Halothane ) ? AV
Dissociation, Electrolyte Chest
Surgery Myocardial Infarction Positive
Breathing Perioperative Cardiac Arrhythmias
Paroxysmal Supraventricular Tachycardia Paroxysma
l ventricular Tachycardia Atrial Flutter, Sinus
Tachycardia AV Nodal Rhythm , AV Block
Sinus Bradycardia, Premature Contraction
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• General Complications

Cardiac Complications -- Myocardial Infarction
Coronary Artery Thrombosis Myocardial
Infarction Anoxia, Hypotension, Hemorrhage,
Dehydration, Fluid Electrolyte Disturbance,
Arrhythmias ECG, SGOT, CPK-MB, BGA, Isotope Scan
Digitalization, Diuretics, Vasopressor Shock
Treatment, Adequate Ventilation, Treat Anemia,
Relief Pain, Sedation, ICU Swan Ganz Catheter
Monitor
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Circulatory
Complications Arterial system Venous
system Lymphatic system
Coronary Artery Embolism Carotid Artery
Embolism Mesenteric Artery Embolism Embolectomy /
Anti-coagulant
Mesenteric Venous Thrombo-phlebitis Thrombo-phlebi
tis of the Limbs Thrombectomy / Facioyomy Gangrene
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• Preoperative Evaluation
• Lung
• Heart
• Liver
• Kidney
• GI
• Others

• O.R.
• Anesthesia
• Pre medication
• NPO
• Fluid e I O
• Others

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