Brief Note on Circulatory Complications (Post Abdominal Surgery)

In this article, we will discuss Brief Note on Circulatory Complications (Post Abdominal Surgery). So, let’s get started.

Circulatory Complications

Haemodynamics

• Increases – Haemorrhage, oedema and hyperemia
• Decreases – Thrombosis, ischaemia and infarction

Thrombosis

It is a clot in the blood that either blocks, or partially blocks a blood vessel and may lead to infarction, or death of tissue, due to a blocked blood supply. As the blood normally flows more slowly through the veins than through the arteries, thrombosis is more common in veins than in arteries. Dehydration also plays a role in the development of thrombosis, and the patient should be kept well hydrated.

Deep Vein Thrombosis

It can happen in one or more of the deep veins often in the legs or pelvis of the lower limb characterized by swelling, warmth and erythema. It is frequently a precursor of a pulmonary embolism. This may occur with prolonged bed rest. The symptoms are a feeling of heaviness, pain, warmth or swelling in the affected part, and sometimes chills and fever, which do not necessarily indicate its severity. The symptoms are:
• 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%.
• Increased temperature
• Tender/swollen calf
• Red/shiny skin
• Homan’s test positive
• Engorged veins/oedema
• Cord-like veins
• Pain along the course of the vein

Embolism (Greek-wedge/stopper)

It is the sudden blocking of an artery by a clot of foreign material. The obstructing material is most often a blood clot, but it may be a fat globule, air bubble, piece of tissue or clump of bacteria.

Pulmonary Embolism

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

It is the obstruction of the pulmonary artery or one of its branches by an embolus. The embolus usually is a blood clot swept into circulation from a large peripheral vein, particularly a vein in the leg or pelvis. The effects of pulmonary embolism will depend on the size of the embolus and the amount of lung tissue involved. When an embolus becomes lodged in a pulmonary blood vessel, it prevents adequate blood supply to the lung, interferes with the exchange of
oxygen and carbon dioxide, and results in arterial hypoxia. Simple, uncomplicated embolism produces such cardiopulmonary symptoms as dyspnea, tachypnoea, persistent cough, pleuritic pain and hemoptysis. Apprehension is a common symptom. On rare occasions the cardiopulmonary symptoms may be acute, occurring suddenly and quickly producing cyanosis and shock.

Symptoms

• Increased temperature, pulse and respiratory rate
• Changes in patient colour
• Severe chest pain/dysnoca
• Pleurisy/blood stained sputum
• Cough, diaphoresis, apprehension
• Low grade fever
• Bulging neck veins
• Altered mental status

Infarction (Latin-stuffed)

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 controlled diabetes mellitus. A major presentation is painful thigh or leg swelling.

Haemorrhage

It is a loss of a large amount of blood in a short period, either externally or internally. Haemorrhage may be arterial, venous or capillary. Symptoms of massive haemorrhage are related to hypovolaemic shock: rapid, thready pulse; thirst; cold, clammy skin; sighing respirations; dizziness, syncope; pallor; apprehension; restlessness; and hypotension. If the haemorrhage continues unchecked, the patient may complaint of visual disturbances, ringing in the ears or extreme weakness.

Classification

Class 1: <15% loss of blood volume
Class 2: 15-30%
Class 3:30-40%
Class 4: <40%

Types of Haemorrhage

• Revealed and concealed haemorrhage
• Primary/reactionary/secondary
haemorrhage
• Surgical/non surgical haemorrhage

Shock

It is a systemic state of low tissue perfusion, which is inadequate for normal cellular respiration. 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 is caused by a fall in blood volume.
• Cardiogenic shock is caused by reduced cardiac output.
• Distributive shock includes infectious, anaphylactic and neurogenic causes.

Oedema

It is the excessive collection of tissue fluid in the interstitial space. 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.

Types

• Pitting oedema-Watery low protein content.
• Inflammatory edema-Thick fluid with high protein content.

Causes of Oedema

1. Increased hydrostatic pressure of blood
2. Decreased osmotie pressure of blood
3. Increased capillary permeability
4. Lymphatic obstruction
5. Slowed flow of blood and lymph

Pressure Sore

Normal capillary pressure is 32 mmHg at arterial end and 15 mmHg at venalend. Any pressure greater than this cause capillary obstruction and ischemia leading to increased permeability of capillary and extravasations of the materials. Pressure more than 40-100 mmHg over a period of 4 hours capable of producing cellular ischaemia and sore.

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