Post-Op Pyrexia Flashcards
What is considered to be early post-op pyrexia?
0-5days post-op
What are the causes of early post-op pyrexia?
Blood transfusion Physiological Pulmonary atelecasis Infection Drug reaction
Give an example of a physiological cause of post-op pyrexia?
SIRS from trauma
When does pyrexia caused by SIRS from trauma occur?
0-1 days
When does pyrexia caused by pulmonary atelectasis occur?
24-48 hours
What infections can cause early post-op pyrexia?
UTI
Superficial thrombophlebitis
Cellulitis
What is considered to be delayed post-op pyrexia?
> 5 days post-op
What are the causes of delayed post-op pyrexia?
Pneumonia VTE Wound infection Anastomotic leak Collection
When does pyrexia caused by VTE occur?
5-10 days post-op
When does pyrexia caused by wound infection occur?
5-7 days post-op
When does pyrexia caused by anastomotic leak occur?
7 days post-op
When does pyrexia caused by collection occur?
5-20 days post-op
What should be examined in a post-op febrile patient?
Observation chart, notes, and drug chart Wound Abdo + DRE Legs Chest Lines Urine Stool
What investigations should be done in post-op febrile patient?
Urine dip and MCS
Blood
Wound swab cultures
CXR
What blood tests should be done in a post-op febrile patient?
FBC
CRP
Cultures
LFTs in some cases
What can cause post-op pneumonia?
Atelectasis due to anaesthesia and pain causing reduced cough
Immunosuppression due to surgery
How is post-op pneumonia managed>
Chest physio to encourage coughing
Good analgesia
Abx
How does a collection present?
Malaise
Swinging fever and rigors
Localised peritonitis
Shoulder tip pain if subphrenic
Where might collections be located?
Pelvic Subphrenic Paracolic gutters Lesser sac Hepatorenal recess Small bowel
When do pelvic collections present?
4-10 days post op
When do suphrenic collection present?
7-21 days post op
What is the hepatorenal recess also known as?
Morrison’s space
Where in the small bowel can collections develop?
Interloop spaces
How might suspected collections be investigated?
FBC, CRP, and cultures
Ultrasound and CT
Diagnostic laparoscopy
How is post-op collections managed?
Abx
Drainage or washout
What is cellulitis?
An acute infection of the subcutaneous connective tissue
What causes cellulitis post-operatively?
ß-haemolytic streps
Staph aureus
How does cellulitis present?
Pain, swelling, erythema, and warmth
Systemic upset
May have lymphadenopathy
How is cellulitis managed?
Benpen IV or pen V and fluclox PO
