(Post-op) Pyrexia Management Flashcards
What are early causes of post-op pyrexia (0-5 days)?
- Blood transfusion
- Cellulitis
- UTI
- Physiological reaction to surgery (usually ~1 days post-op)
- Pulmonary atelectasis - often listed, evidence is limited
Early post-operative pyrexia can arise from various causes, necessitating careful monitoring.
What are late causes of post-op pyrexia (>5 days)?
- VTE
- Pneumonia
- Wound
- Infection
- Anastomotic leak
Identifying late causes is crucial for effective management of post-operative fever.
What is a memory aid for postoperative fever?
- Wind (atelectasis)
- Water (UTI)
- Wound
- Walking (VTE)
- What did we do / wonder drugs
The 5 W’s help in recalling potential causes of postoperative fever.
What are the components of a focused exam for post-op pyrexia?
- SSI
- Wound
- Deep abscess - Ix & Dx requires CT abdomen
- Anastomotic leak
- Pneumonia
- UTI
- Line infection - especially PICC line
A thorough examination can help identify the underlying cause of fever.
What imaging studies are used in the investigation of post-op pyrexia?
- CXR
- Contrast CT for anastomotic leak
Imaging plays a critical role in diagnosing complications associated with post-operative fever.
What blood tests are performed in the investigation of post-op pyrexia?
- FBC
- U&E
- LFTs
- CRP
- VBG (lactate)
Blood tests help assess the patient’s overall condition and detect infections.
What does a urine dipstick reveal in the diagnosis of UTI?
- Nitrites + leukocytes = Dx of UTI
- Haematuria
What cultures are taken during the investigation of post-op pyrexia?
- MSU
- Blood
- Wound swab
Cultures are essential for identifying the causative organisms in infections.
When does an anastomotic leak usually present post-op?
Usually presents 5-7 days post-op
Timely recognition of anastomotic leaks is vital for effective management.
What are the risk factors for anastomotic leak?
- Patient factors: smoking, obesity, malnutrition, drugs (e.g. steroids)
- Surgical factors: emergency surgery, peritoneal contamination, esophageal-gastric or rectal anastomosis
Understanding risk factors can help in preventing anastomotic leaks.
What is the initial treatment for an anastomotic leak?
- Make patient NPO
- Start broad-spectrum ABx
Immediate action is necessary to manage anastomotic leaks effectively.
What is the management for minor leaks (<5 cm)?
Will usually settle with broad-spectrum ABs
What is required for larger anastomotic leaks?
Percutaneous drainage
What is required for sepsis or multiple collections in the case of an anastomotic leak?
Exploratory laparotomy
