This document classifies surgical conditions and discusses how certain medical conditions can affect surgical treatment outcomes. Surgical conditions are classified as emergency, urgent, or elective depending on how vital the surgery is. Emergency surgeries treat life-threatening injuries or issues. Urgent surgeries are needed within days. Elective surgeries are non-life-threatening and can be scheduled in advance. Medical conditions like diabetes, obesity, bleeding disorders and thyroid issues can impact healing if not properly managed before and after surgery. Close monitoring and treatment of underlying conditions is important for reducing surgical risks.
2. Surgery is classified according to whether it is
vital to life, necessary for continued health or
desirable or personal reasons.
It can be classified into:
Emergency surgical conditions
Urgent surgical conditions
Elective surgical conditions
3. Emergency Surgical conditions
It refers to unpredictable events that result in
the need for immediate surgical attention.
Also called emergency surgeries.E.g.
Injury from
An automobile
A violent assault
A fire
4. A sudden change in chronic medical problem
such as a perforated peptic ulcer or a
strangulated hernia.
Emergency cases typically involve treatment
of:
Gunshot and stab wounds
Fractures of the skull and other major bones
5. Head injury with other intracranial hematoma
and lateralizing signs
Multiple injuries
Severe eye injuries
Acute airway obstruction e.g. chocking
6. Acute abdomen: presenting as acute onset
severe pain in the abdomen area for which
immediate surgery might be the remedy.
i. Acute appendicitis
ii. Intestinal obstruction
iii. Intussusception
iv. Testicular torsion
7. Urgent surgical conditions
It refers to cases in which an operation is vital
but can be postponed for a few days.E.g.
Cancer of a vital organ
Acute cholecystitis
Acute diverticulitis
Kidney stones
Injury with minor bone fracture
9. Required Elective surgery
It includes physical ailments that are serious
enough to need corrective surgery but that
can be scheduled weeks or months in
advance.
10. Selective Elective surgery
This covers a broad range of conditions that
are of no real threat to the immediate
physical health of the patient, but
nevertheless should be corrected by surgery
in order to improve comfort and emotional
health.E.g. cleft lip and cleft palate, removal
of certain cysts and benign fatty or fibrous
tumours.
11. Optional Elective surgery
This includes operations that are primarily of
cosmetic benefit.
E.g. removal of warts and other non
malignant growths on the skin, blemishes on
the skin and cosmetic surgery undertaken for
cosmetic reasons.
13. There are a number of medical conditions
that can affect the outcome of surgical
treatment.
These are :
Diabetes mellitus
Anaemia
Haemoglobinopathies
14. Bleeding disorders
Varicose veins, leg swelling and DVT
Hypertension
Obesity
Jaundice
Thyrotoxicosis
16. Diabetes Mellitus
Blood sugar levels must be under control
before surgery.
Uncontrolled diabetes can slow the healing of
a surgical wound
It also predisposes one to post operative
infection
17. Surgery can cause increased stress to the
body and higher blood sugar.
Insulin dose may need to be adjusted.
Diabetics patient are at specific risk from
general anaesthesia and surgery due to the
following reasons:
18. Certain complications of diabetes are
associated with a higher post operative risk
Stress(e.g. surgery, trauma and infection)
cause increased production of catabolic
hormones which oppose the action of insulin,
hence making diabetic control more difficult.
19. General anesthesia, surgery ,deprivation of
oral intake and post operative vomiting
disrupt the delicate balance between dietary
intake ,exercise(energy utilization) and
diabetic therapy.
Diabetic ketoacidosis may cause an elevated
leucocyte count and raised amylase level
which may confuse the diagnosis of acute
abdomen..
20. DKA may sometimes present with abdominal
pain
Diabetic patients are at greater risk of
hospital acquired infections.
21. Diabetes mellitus…..
Perioperative management of insulin
dependent diabetics:
Establish good diabetic control before
operation
Give soluble insulin as a continuous
intravenous infusion during the operative
period
22. Give an infusion of dextrose throughout the
operative period to balance the insulin given
and to make up for lack of dietary intake
Add potassium to the dextrose infusion
Monitor blood glucose and electrolytes
frequently throughout the operative and
early post operative period.
23. Diabetics controlled on oral hypoglycaemic
agents:
Maintain on short acting sulphonylureas such
as glipizide(omit dose on the day of
operation)
Patients on long acting drugs such as
metformin should be changed to short acting
sulphonylureas several days before the
operation.
24. If this fails to provide adequate control, an
insulin regimen can be used.
25. Diabetics controlled by diet alone:
These do not require special preoperative
measures as they do not become
hypoglycaemic and blood glucose rarely drifts
above acceptable levels.
26. Anaemia
Anaemia increases the risk of cardiac and
wound complications during surgery.
Full blood count should be done before
surgery.
Haemoglobin level must be checked.
27. Haemoglobinopathies
Patients with sickle cell disease and beta
thalassaemia have a high operative morbidity
and mortality
They require intensive perioperative
management with particular attention to
avoiding hypoxia,infection,acidosis,
dehydration and hypothermia.
29. Most surgical bleeding problems are caused
by :
Poorly controlled anticoagulant therapy
Liver disease
Aspirin therapy
Vitamin k mal-absorption such as in
obstructive jaundice
30. Varicose Veins, Leg Swelling, DVT
Surgery and post-operative immobility
increases the risk of DVT
Blood clots can be dislodged leading to
embolism into the lungs
31. Hypertension
Blood pressure control is necessary before
surgery
High blood pressure control can lead to
excessive haemorrhage during surgery
32. Obesity
Overweight and obese patients are at
increased risk of medical and surgical
complications including wound
infections,pneumonia,blood clots and heart
attack.
Losing weight before surgery would improve
the outcome of surgery.
33. Surgical complications of obesity
Cardiopulmonary complications such as
cardiac failure and chest infections
Wound complications such as infections,
wound dehiscence and burst abdomen
Venous thromboembolism-increased risk of
deep venous thrombosis pulmonary
embolism
34. General anaesthetic complications
Anatomical problems e.g. intravenous canulae
are difficult to insert and intubation is more
difficult. Clinical signs of dehydration and
hypovolaemia are more difficult to elicit.
Physiological problems: metabolic issues such
as altered distribution of drugs.
35. Predisposition to various medical disorders
Hypertension
Ischaemic heart disease
Type 2 diabetes
Gallstones
Gout
36. Operative difficulties
Operations take longer time to perform
because of difficult access and vital structures
obscured by fat
This leads to a higher incidence of anesthetic
and surgical complications, particularly
involving the wound.
37. Problems of manual handling of patients who are markedly overweight
Weight and size limitations of standard
equipment,e.g. CT scanners, operating tables,
beds
Risks to staffs involved in lifting and handling
38. Jaundice
Jaundice delays post operative wound
healing
Vitamin K malabsorption in obstructive
jaundice can lead to excessive bleeding.
39. Thyrotoxicosis
Thyroid and non thyroid surgery for a patient
with uncontrolled thyrotoxicosis carries a risk
of thyrotoxic crisis attendant high mortality
It can increase the risk of cardiac
complications
Hyperthyroidism must be controlled before
surgery.
40. The patient must be rendered euthyroid
before operation using antithyroid drugs and
beta blocking agents
Non selective beta blocking agents rapidly
control the cardiovascular effects of
thyrotoxicosis and be used for urgent
perioperative preparations.
41. Hypothyroidism
These patients have moderate risk when
undergoing surgery.
They are more sensitive to CNS depressants
have decreased cardiovascular reserve and
are also susceptible to electrolyte disorders
such as water retention.
42. If there is clinical suspicion of hypothyroidism,
operation should be delayed or postponed
until oral replacement is initiated.
43. Arrthmias
A problem with the rate or rhythm of the
heartbeat.
Tachycardia
Bradycardia
Irregular heart beat
Can lead to operative and post operative
complications
44. Adrenal Insufficiency
Patients with adrenal insufficiency must be
give steroid cover during the perioperative
period. Intravenous injection hydrocortisone
25-50mg prior to operation and 50mg daily
until recovery.
45. Lack of additional adrenal response to the
stresses of surgery or trauma may cause acute
postoperative cardiovascular collapse with
hypotension and shock ( Addisonian crisis)
46. Cushing’s Syndrome
This result from excess secretion of cortisol
Long term steroid therapy for conditions such
as rheumatoid arthritis or asthma is the most
common cause of cushingoid features
Cushingoid patients suffer are predisposed to
Hypertension
Hyperglycaemia