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Clerkship - Post Operative Complications

CLERKSHIP LEARNING OBJECTIVES

  1. Describe the differential diagnosis of a patient having postoperative fever. For each entity, discuss the clinical manifestations, appropriate diagnostic work-up, and management.
  2. Discuss the following wound complications in terms of predisposing risk factors (patient condition, type of operation, technique), as well as their recognition, treatment, and prevention:
    • hematoma and seroma
    • wound infection
    • dehiscence
    • incisional hernia
  3. Discuss the various causes of respiratory distress and respiratory insufficiency that may occur in the postoperative patient. For each complication, describe the etiology, clinical presentation, management, and methods of prevention:
    • atelectasis
    • pneumonia
    • aspiration
    • pulmonary edema
    • pulmonary embolism (including deep venous thrombosis)
    • fat embolism
  4. Discuss the diagnostic work-up and treatment of oliguria in the postoperative period. Include pre-renal, renal, and post-renal causes (including urinary retention).
  5. Discuss the possible causes of hypotension which may occur in the postoperative period. For each etiology describe its pathophysiology and treatment:
    • hypovolemia
    • sepsis
    • cardiogenic shock - including postoperative myocardial infarction
    • fluid overload
    • arrhythmias
    • pericardial tamponade
    • medication effects
  6. Describe the management of postoperative chest pain.
  7. Describe factors which can lead to abnormal bleeding postoperatively, and discuss its prevention and management:
    • Surgical site - inherited and acquired factor deficiencies
    • DIC
    • transfusion reactions
    • operative technique
    • gastroduodenal (i.e. stress ulcerations)
  8. Discuss disorders of alimentary tract function following laparotomy which may produce nausea, vomiting, and/or abdominal distension:
    • paralytic ileus
    • acute gastric dilatation
    • intestinal obstruction
    • fecal impaction
  9. Describe the factors which can give rise to alterations in cognitive function postoperatively, as well as their evaluation and treatment. Alterations in cognitive function:
    • hypoxia
    • metabolic
    • alcohol withdrawal

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