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Alcohol withdrawal
2%
1/49
Surgical error
4%
2/49
Post-operative ileus
16%
8/49
Urinary tract infection
Wound infection
55%
27/49
Select Answer to see Preferred Response
The patient is presenting with fever and bandemia, one week status post a surgical procedure with evidence of redness and tenderness at the surgical site. This is most suspicious for a wound infection. A wound infection normally presents as a post-operative fever and leukocytosis one week following a surgical procedure. It is diagnosed clinically with additional evidence of localized erythema, warmth, and pain at the incision site. There may also be purulent wound drainage or compromised wound integrity. Diabetes, obesity, immunosuppression, smoking, and malnutrition can increase the risk of surgical site infection. Other common causes of post-operative fever and their time course include: atelectasis within 24 hours, urinary tract infection on day three, deep venous thrombosis or pulmonary embolus on day five, and deep abscess or drug reaction on day ten. Incorrect Answers: Answer 1: Alcohol withdrawal usually presents five days after the patient’s last drink. Signs and symptoms include disorientation, low grade fever, sweating, hypertension, tachycardia, and tremors. If unrecognized and untreated, it may escalate to seizures and hallucinations. Answer 2: Surgical error, such as transection of the ureter, is a risk in pelvic surgery. However, this patient’s urine output is adequate, and an intraoperative cystoscopy had been performed and was unremarkable. Symptoms can include zero to low urine volume, hematuria, tender abdomen, involuntary guarding, and flank pain. Answer 3: Post-operative ileus can commonly occur following abdominal surgery but will be diagnosed as prolonged post-operative ileus around day five or six. Symptoms include absence of flatus or stool, post-operative nausea and vomiting, pain with oral intake, and abdominal distension. Low grade fever and an elevated WBC may also be seen. Answer 4: Urinary tract infections can cause post-operative fever, which normally present three days after surgery. The urinalysis may be positive for hematuria, pyuria, leukocyte esterase, nitrites, or bacteria > 100 cfu/mL on catherized specimen or > 100,000 cfu/mL on clean catch. Bullet Summary: Wound infections are common causes of post-operative fever and leukocytosis, often presenting around one week following surgery with redness and tenderness to palpation surrounding the surgical site.
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