General Surgery Board Review Perioperative Care & Complications Flashcards

Anastomotic leak after colorectal surgery most commonly presents on which postoperative day?

Answer: POD 5–7

Anastomotic leaks typically manifest on POD 5–7 when the inflammatory phase peaks and edema subsides, reducing tissue holding strength at the suture line.

What is the most common cause of fever within the first 24 hours after a major abdominal operation?

Answer: Atelectasis and pulmonary inflammatory response

Atelectasis causing ventilation-perfusion mismatch and the systemic inflammatory response to surgery are the most common causes of early postoperative fever in the first 24 hours.

Which complication is most specifically associated with splenectomy and requires lifelong vaccination and potential prophylactic antibiotics?

Answer: Overwhelming post-splenectomy infection (OPSI)

OPSI, caused by encapsulated organisms (S. pneumoniae, H. influenzae, N. meningitidis), is a potentially fatal complication requiring immunization before or after splenectomy.

A patient develops fever, tachycardia, hypotension, and CT findings of free intraperitoneal air on POD 3 after a sigmoid colectomy. What is the next step?

Answer: Immediate return to the operating room for exploratory laparotomy

Free intraperitoneal air with hemodynamic instability indicates an anastomotic leak with peritonitis, requiring immediate operative exploration and repair or fecal diversion.

Chylous ascites after retroperitoneal lymph node dissection is best managed initially with which approach?

Answer: Low-fat diet with medium-chain triglycerides or total parenteral nutrition

Initial management of chylous ascites is conservative — a low-fat diet supplemented with MCT oil (or TPN) reduces chyle flow through the lymphatic system, allowing spontaneous healing.

Early dumping syndrome after Roux-en-Y gastric bypass or pyloroplasty is best characterized by which pathophysiology?

Answer: Rapid gastric emptying causing fluid shifts into the bowel and osmotic effects

Early dumping occurs within 10–30 minutes of eating; rapid gastric emptying floods the small bowel with hyperosmolar content, causing fluid shifts, distension, and vasomotor symptoms.