Causes of postoperative hepatic dysfunction
- Increased bilirubin load
- Blood transfusion
- Haemolysis
- Haemolytic disorders
- Abnormalities of bilirubin metabolism
- Hepatocellular damage
- Pre-existing hepatic disease
- Viral hepatitis
- Sepsis
- Hypotension
- Hypoxaemia
- Drug-induce hepatitis
- Congestive cardiac failure
- General anaesthetic induced hepatic necrosis
- Extra-hepatic biliary obstruction
- Gallstones
- Ascending cholangitis
- Pancreatitis
- Common bile duct injury
Causes of postoperative renal failure
- Prerenal (hypoperfusion)
- Shock (hypovolaemia, cardiogenic, septic)
- Renal artery disease
- Renal (direct injury)
- Acute tubular necrosis (following prerenal, drugs, myoglobin)
- Glomerulonephritis
- Interstitial nephritis
- Postrenal (obstruction)
- Bladder outflow obstruction
- Single ureter (calculus, tumour)
- Both ureters (bladder malignancy)
Urinary tract infections
- 10% of patients admitted to hospital have a urinary catheter inserted
- Risk of catheter-related infection depends on:
- Age and sex of patient
- Duration of catheterisation
- Indication for catheterisation
- Bacterial colonisation of catheters is common
- If catheter required for more than 2 weeks 90% patients will develop bacteriuria
- Commonest organisms are enterobacter and enterococci
- Does not require treatment unless patient is systemically unwell
- Infection can be prevented by:
- Maintaining closed drainage system
- High infection control standards
- Preventing backflow from catheter bag
Postoperative confusion
- Occurs in 10% of postoperative patients
- Associated with increased morbidity and morality
- Leads to increased duration of hospitalisation
- Clinical features include
- Reduced level of consciousness
- Impaired thinking
- Impaired memory
- Perceptional abnormalities
- Disturbed emotion
- Psychomotor disturbance
Causes
- Hypoxia - respiratory disease, cardiac failure, arrhythmia
- Trauma - head injury
- Infection - intracranial, extracranial
- Neoplasia - primary and secondary cerebral tumours
- Vitamin deficiency - Thiamine (Wernicke's encephalopathy), B12 deficiency
- Endocrine - hypothyroidism, hyperthyroidism, Addison's disease
- Degenerative
- Vascular - CVA, TIAs
- Drugs
- Metabolic derangement
Bibliography
Edwards B F. Postoperative renal insufficiency. Med Clin North Am 2001; 85:
1241-1254.
Molina E G, Reddy K R. Postoperative jaundice. Clin Liver Dis 1999; 3:
477-488.
Reddy V G. Prevention of postoperative acute renal failure. Postgrad Med J 2002;
48: 64-70.
Winawer N. Postoperative delirium. Med Clin North Am 2001; 85: 1229-1239. |