🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Post-surgical care and complications

Specialties > Emergency medicine and intensive care

Differential Diagnosis Schema 🧠

Infectious Complications

  • Surgical site infection (SSI): Redness, swelling, warmth, and purulent discharge at the incision site; fever and increased pain.
  • Pneumonia: Common in patients with poor mobility or underlying lung disease; presents with cough, dyspnea, fever, and infiltrates on chest X-ray.
  • Urinary tract infection (UTI): Associated with catheter use; presents with dysuria, frequency, urgency, and possibly fever.
  • Sepsis: Widespread infection causing fever, tachycardia, hypotension, and altered mental status; may arise from any site of infection.
  • Deep abscess: Often presents later with localized pain, fever, and sometimes drainage from the wound site.

Thromboembolic Complications

  • Deep vein thrombosis (DVT): Unilateral leg swelling, pain, and erythema; risk increased by immobility and certain surgeries.
  • Pulmonary embolism (PE): Sudden onset dyspnea, pleuritic chest pain, tachycardia, and hypoxia; can be fatal if not promptly treated.
  • Stroke: Particularly in patients with atrial fibrillation or hypercoagulable states; presents with sudden neurological deficits.
  • Myocardial infarction (MI): Postoperative chest pain, dyspnea, nausea, or diaphoresis, especially in those with cardiovascular risk factors.
  • Ischemic limb: Can occur after vascular surgery or prolonged immobilization; presents with pain, pallor, pulselessness, and paresthesia.

Respiratory Complications

  • Atelectasis: Common in the early postoperative period; presents with dyspnea, tachypnea, and decreased breath sounds.
  • Pneumonia: Especially in patients with poor cough reflex or prolonged intubation; presents with fever, productive cough, and infiltrates on chest X-ray.
  • Pulmonary embolism: Sudden onset of dyspnea, chest pain, and tachycardia; often postoperatively due to immobilization.
  • Pleural effusion: Fluid accumulation leading to dyspnea, dullness to percussion, and decreased breath sounds; often seen after thoracic surgery.
  • Pneumothorax: May occur after procedures involving the chest; presents with sudden dyspnea, chest pain, and decreased breath sounds on the affected side.

Gastrointestinal Complications

  • Ileus: Common after abdominal surgery; presents with abdominal distension, pain, and absence of bowel sounds.
  • Anastomotic leak: Post-surgical complication of bowel surgery; presents with fever, abdominal pain, and peritonitis.
  • Bowel obstruction: Can occur due to adhesions or herniation; presents with abdominal pain, vomiting, and absence of bowel movements.
  • C. difficile infection: Associated with antibiotic use; presents with diarrhea, abdominal pain, and fever.
  • Acute pancreatitis: May follow biliary surgery; presents with epigastric pain radiating to the back, nausea, and vomiting.
  • Hepatic dysfunction: Postoperative jaundice or liver enzyme abnormalities, particularly after major surgery or in patients with pre-existing liver disease.
  • GI bleeding: Postoperative stress ulcers or anastomotic bleeding; presents with hematemesis, melena, or hematochezia.

Key Points in History 🥼

Surgical Details

  • Type of surgery: Understanding the specific procedure helps anticipate common complications (e.g., bowel surgery and ileus).
  • Timing of surgery: Early vs. late complications may differ (e.g., DVTs are more common a few days postoperatively).
  • Intraoperative events: Any complications during surgery, such as significant blood loss, may affect postoperative recovery.
  • Anesthesia type: General anesthesia can increase the risk of respiratory complications, while regional anesthesia may have specific risks.
  • Duration of surgery: Longer procedures are associated with higher risks of complications like DVT or pneumonia.
  • Postoperative care: Details about immediate postoperative care, including fluid management, pain control, and early mobilization.
  • Use of prophylaxis: Includes DVT prophylaxis, antibiotics, and other measures to prevent complications.
  • Catheterization: Presence and duration of urinary or central catheters, as these can increase infection risks.

Patient Factors

  • Age and comorbidities: Older patients and those with comorbidities (e.g., diabetes, COPD, cardiovascular disease) are at higher risk of complications.
  • Nutritional status: Malnourished patients are at increased risk of infection, poor wound healing, and other complications.
  • Preoperative functional status: Limited mobility or pre-existing respiratory issues can predispose to postoperative complications.
  • Smoking and alcohol use: These habits can impair healing, increase infection risk, and complicate anesthesia.
  • Medication history: Including anticoagulants, immunosuppressants, and steroids, which can influence the risk of bleeding, infection, and healing.
  • Allergies: Important to note, particularly to medications, which may impact postoperative management.
  • Psychosocial factors: Anxiety, depression, or lack of social support can affect postoperative recovery.
  • Previous surgeries: History of complications with anesthesia or surgery can guide current management.
  • Family history: Particularly relevant for thromboembolic disorders, which may increase postoperative DVT/PE risk.
  • Recent infections: Pre-existing infections can complicate postoperative recovery and increase the risk of sepsis.
  • Recent travel: Consider for thromboembolic risk if the patient has been on long-haul flights or immobile before surgery.
  • Immunization history: Particularly relevant in patients at risk of postoperative pneumonia or other infections.
  • Social history: Includes living situation and access to postoperative care, which may influence discharge planning and recovery.
  • Occupational history: Physical demands of the job may impact the patient’s recovery and need for rehabilitation.

Possible Investigations 🌡️

Laboratory Tests

  • Full blood count (FBC): To assess for infection (leukocytosis), anemia (postoperative bleeding), or other abnormalities.
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Elevated in infection, inflammation, or sepsis.
  • Urea and electrolytes (U&E): To monitor renal function, particularly in patients at risk of dehydration or on nephrotoxic drugs.
  • Liver function tests (LFTs): To assess for hepatic dysfunction, particularly in patients undergoing abdominal surgery or on certain medications.
  • Coagulation profile: Important in patients with a history of bleeding disorders or those on anticoagulant therapy.
  • Arterial blood gases (ABG): Useful in assessing respiratory function, particularly in patients with postoperative respiratory complications.
  • Blood cultures: Indicated in cases of suspected sepsis or unexplained fever.
  • Urinalysis: To check for urinary tract infection, particularly in catheterized patients.
  • Wound swabs: To identify the causative organism in cases of suspected surgical site infection.
  • D-dimer: Elevated in cases of DVT/PE, but non-specific; should be used alongside clinical assessment and imaging.
  • Cardiac enzymes (e.g., troponins): Indicated if myocardial infarction is suspected postoperatively.
  • Serum amylase and lipase: Elevated in cases of suspected acute pancreatitis.
  • Glucose levels: Important in managing diabetic patients or those at risk of hyperglycemia due to stress response.
  • Lactate levels: Elevated in sepsis, shock, or significant hypoperfusion.
  • Serum albumin: Low levels may indicate malnutrition, liver dysfunction, or acute inflammatory response.
  • Procalcitonin: Can be elevated in bacterial infections, helping to differentiate from viral infections or non-infective causes.
  • Thyroid function tests: Relevant in patients with known thyroid disease or unexplained symptoms postoperatively.
  • Type and screen/crossmatch: Necessary for patients at risk of requiring transfusion postoperatively.
  • Blood glucose: To monitor for hyperglycemia, especially in diabetic patients or those with postoperative stress hyperglycemia.
  • Calcium and magnesium levels: Important in patients at risk of electrolyte disturbances due to surgery or medications.
  • Serum cortisol: Consider in patients on chronic steroid therapy or those showing signs of adrenal insufficiency.
  • Urine output monitoring: Helps assess renal function and fluid status postoperatively.
  • Thrombophilia screen: Consider in patients with a history of thromboembolic events or unexpected DVT/PE postoperatively.

Imaging and Other Tests

  • Chest X-ray: Useful in assessing for atelectasis, pneumonia, pneumothorax, or pleural effusion postoperatively.
  • Ultrasound: To evaluate for DVT, abscesses, or collections in the abdomen or pelvis.
  • CT scan: Consider for detailed evaluation of suspected anastomotic leak, abscess, or pulmonary embolism.
  • Echocardiography: Useful in assessing cardiac function postoperatively, especially in patients with new or worsening heart failure symptoms.
  • ECG: Important in evaluating postoperative chest pain, palpitations, or suspected myocardial infarction.
  • MRI: May be used for detailed imaging of soft tissue complications or in assessing certain types of surgical complications.
  • Doppler studies: To assess blood flow in suspected cases of DVT or arterial occlusion.
  • Bronchoscopy: Consider if there is suspicion of airway obstruction or to assess for aspiration in patients with respiratory complications.
  • Endoscopy: Indicated in cases of suspected anastomotic leak, GI bleeding, or post-surgical strictures.
  • Arterial blood gases (ABG): To assess oxygenation and acid-base status, particularly in patients with respiratory or metabolic complications.
  • Pulmonary function tests (PFTs): Useful in assessing respiratory function in patients with pre-existing lung disease.
  • Barium swallow: To assess for esophageal leaks or strictures post-esophageal surgery.
  • Thromboelastography (TEG): Consider in complex cases to assess the coagulation status, especially in patients with coagulopathies.
  • Cardiac monitoring: Continuous monitoring may be required in patients at high risk for arrhythmias postoperatively.
  • Wound exploration: In cases of suspected deep surgical site infection or abscess formation.
  • Urinary catheterization: To monitor urine output accurately in patients with significant fluid shifts or renal complications.
  • Nasogastric (NG) tube: For decompression in cases of ileus, bowel obstruction, or gastric stasis.
  • End-tidal CO2 monitoring: To assess ventilation in patients with respiratory complications.
  • Venography: May be used in cases of suspected venous thrombosis not clearly identified by ultrasound.
  • Bone scan: Consider in patients with suspected osteomyelitis or other bone-related complications postoperatively.

No comments yet 😉

Leave a Reply

Emergency medicine and intensive care