A 38 years old patient has comes in emergency department with ruptured gall bladder, cholecystectomy has done. The patient is discharged with follow up instructions. After 2-3 weeks the patient comes for follow up in surgical OPD with complain of pain abdomen, generalized tenderness in abdomen, fever etc. What would be the possible complication?

1. A

   Peritonitis

2. B

   Gastritis

3. C

   Evisceration

4. D

   Dehiscence

Appeared in: NORCET -4 , 2023

Explanation

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• The patient's triad of symptoms—generalized abdominal pain, tenderness, and fever—are the cardinal signs of peritonitis.
• Peritonitis is the inflammation of the peritoneum, the lining of the abdominal cavity.
• A ruptured gallbladder, the patient's initial problem, is a common cause of secondary bacterial peritonitis due to the spillage of infected bile.
• Even after cholecystectomy, a residual infection or a slow bile leak can manifest as peritonitis weeks after the initial surgery.

Why Other Options Were Wrong

• Option B: Gastritis is the inflammation of the stomach lining. Its symptoms are typically epigastric pain, nausea, and indigestion, which do not match the patient's presentation of generalized tenderness and fever.
• Option C: Evisceration is the protrusion of internal organs through a surgical incision. It is a visible, external complication and a surgical emergency, not an internal infection presenting with pain and fever.
• Option D: Dehiscence is the separation of the layers of a surgical wound. It is a localized complication at the incision site. The patient's symptoms are generalized throughout the abdomen, indicating a more widespread process.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Recognition of postoperative complications following abdominal surgery, specifically peritonitis in acute care settings.
• Nurses must be vigilant in assessing postoperative abdominal surgery patients for signs of peritonitis, as early detection is crucial to prevent sepsis, septic shock, and death.
• Key nursing assessments include monitoring vital signs for fever and tachycardia, performing regular abdominal exams (assessing for bowel sounds, rigidity, and tenderness), and reviewing lab results for elevated white blood cell counts.
• What if the patient's pain was localized to the right upper quadrant, sharp, and occurred after eating a fatty meal, but there was no fever or generalized tenderness? This might suggest a retained bile duct stone or sphincter of Oddi dysfunction, a different post-cholecystectomy complication.

How to Approach the Question

• First, analyze the patient's history. Note the key events: a ruptured gallbladder (source of contamination) and a recent cholecystectomy (abdominal surgery).
• Next, identify the key symptoms in the current presentation: generalized abdominal pain, generalized tenderness, and fever. These point to a widespread, systemic inflammatory response.
• Correlate the history with the symptoms. The initial organ rupture provided a source for infection, and the current generalized symptoms suggest that the infection has spread within the abdominal cavity.
• Evaluate each option against this clinical picture. Peritonitis is a widespread inflammation of the abdominal lining, which perfectly matches the scenario.
• Rule out the other options based on their definitions. Gastritis is an inflammation of the stomach. Dehiscence and evisceration are complications of the surgical wound itself, not a generalized internal process.

Concept Tested & Keywords

• Concept Tested: Recognition of postoperative complications following abdominal surgery, specifically peritonitis.
• Stem keywords: ruptured gall bladder, cholecystectomy, postoperative, pain abdomen, generalized tenderness, fever
• Lead-in keywords: possible complication
• Clinical cues: A history of a ruptured gallbladder is a significant risk factor for peritoneal contamination and subsequent infection.
• Clinical cues: The onset of symptoms 2-3 weeks after surgery suggests a developing or residual infectious process rather than an immediate postoperative event.

Question ID

QjgwT-QZUj9zC10oBOCQQL

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 pp. 501-503, 637-639