It can occur as a complication usually 48 hours onwards.
Patient present with cough , fever, sob
Investigation: CXR
Rx: Antibiotics (amoxicillin)
B. URINARY TRACT INFECTION:
Usually secondary to catheterization
In elderly patient it can cause dysuria, frequency
Investigation: MSU
Rx: antibiotics (Trimethoprim)
C. ATELECTASIS:
Lung collapse.
Common in people who smoke.
Presentation: Chest pain and mild fever.
Usually occurs within first 48 hours after an operation which is close to the lung especially splenectomy.
Investigations: CXR to R/O pneimonia.
Rx: Physiotherapy.
D. WOUND INFECTION:
Usually after 5 days post operative.
Patient present with discharge from the wound, redness & tenderness around the wound.
Investigations: wound swab, microscopy, culture and sensitivity.
Rx: Antibiotics
E. INTRA-ABDOMINAL ABSCESS:
Subphrenic abscess or sub hepatic abscess
Usually after 5 days post operative.
Patient presents with swinging fever.
Investigations: CT abdomen
Rx: Incision & drainage
F. ANASTOMOTIC LEAK:
Usually after bowel resection
Any physiological change after bowel resection is alwys anastomotic leak until proven otherwise.
Never occur immediately after operation but after patient starts eating and drinking, usually 3-7 post operative day.
Investigation: CT abdomen
Rx: Antibiotics: IV immediately (cefuroxime+metronidazole)
Laparotomy is the definitive treatment.
INTRA-ABDOMINAL BLEED:
Usually few hours after surgery
Management : Laparotomy
CONFUSION: It can be caused by:
A. INFECTION:
UTI
Pneumonia
usually in elderly and after 5 post operative day
B. MEDICATIONS:
Opiate usually used during an operation
HYPOXIA/ SOB /DYSPNOEA:
A. PULMONARY EMBOLISM : chest pain, hamoptysis, 5 days onwards after an operation
B. PULMONARY OEDEMA: Post operative pulmonary oedema is almost always due to fluid overload.
C. PNEUMONIA
D. PNEUMOTHORAX:
Usually occurs due to ventilation pressure especially if there was a small pneumothorax.
Chest drain must be inserted if it is small.
E. MYOCARDIAL INFARCTION:
Patient presents with chest pain radiating to the left arm.
HYPOTENSION:
A. BLEEDING: IV Fluid
OTHER MEDICAL CONDITIONS : MI, PE or Sepsis
OLIGURIA:
Post operative oliguria is almost secondary to inadequate fluid replacement.
Rx: IV Fluid
ANURIA:
Almost always due to blocked cathter
Check catheter
POSTOPERATIVE HYPONATRAEMIA:
A. SIADH: especiall after brain surgery
B. Over hydration, especially with colloids because sodium gets diluted.
DEEP VENOUS THROMBOEMBOLISM:
Pteinets usually present with unilateral calf swelling, pitting oedema, calf pain.
In post-operative patients we do not use D-dimer as an investigation. But the investigation of choice is always a Compression Ultrasound Scan.
SPECIFIC POST-OPERATIVE COMPLICATIONS
1. MASTECTOMY:
Common complication in lymphoedema (arm becomes swollen)
Rx: Physiotherapy and arm exercise.
2. THYROIDECTOMY:
A. RECURRENT LARYNGEAL NERVE PALSY:
Patient presents with hoarseness of voice.
Usually resolves after 2-3 weeks if unilateral so just reassure.
If bilateral , needs surgical airway.
B. TRACHEAL OBSTRUCTION BY HAEMATOMA:
Usually presents with acute shortness of breath and stridor immediately after operation.
Commonly seen when patient is still in recovery room
Rx: release the stitches on the bedside
C. HYPOCALCAEMIA:
Usually due to injury or aberrant removal of parathyroid glands during surgery.
Patient presents with tetani, Chvostek sign and Troseau’s sign (carpopedal spasm), muscle irritability.
3. POST TURP SYNDROME:
The irrigation fluid used to visualize and distend the urethra and bladder gains intravascular access through the venous circulation causing dilutional hyponatremia.
Rx: Fluid restriction.
4. APPENDICECTOMY:
Common complication is abdominal and pelvic abscess especially if it is perforated or gangrenous appendicitis.
Usually patient will have swinging fever
Investigations: CT scan abdomen or abdominal ultrasound
Rx: I & D
5. SPLENECTOMY:
Spleen takes part in immune system so splenectomy cause low immune funtion and patient will have recurrent infections.
Prophylaxis vaccine is required against following infections:
– Pneumococcal
-Meningococcal
– Haemophilus influenza
Patient also requires long term antibiotics prophylaxis.
6. ABDOMINAL SURGERY:
A. PARALYTIC ILEUS:
Usually presents with abdominal distention, constipation, vomiting and reduced bowel sounds.
Protection