SurgSpace / Specialties / General Surgery
General Surgery
The abdomen and its contents, the acute abdomen, hernias, biliary disease, bowel, breast and endocrine surgery, and the foundation every other surgical specialty builds on.
Backdrop: A laparoscopic operating theatre mid-case · Dr.jayesh amin · CC BY-SA 3.0
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 1 · lap chole
Temp 37.9
HR 92
Drain: 40 mL bilious
RUQ tenderness
Home today as planned?
The read
Not with bile in the drain. A cystic stump leak or a duct injury declares itself exactly like this; LFTs, an ultrasound, and a senior review come before any discharge letter. The low-grade fever alone would be forgivable; the drain's colour is not.
POD 5 · bowel resection
New AF at 132
Temp 38.2
CRP rising again
Abdomen slightly more tender
Rate-control and move on?
The read
Treat the AF and hunt its cause: new AF on POD 5 after an anastomosis is a leak until proven otherwise. The rhythm is the messenger, not the message: CT with contrast, cultures, and the operating surgeon informed today.
POD 3 · laparotomy
No flatus
Distended, quiet abdomen
Vomited once overnight
Obs otherwise well
Ileus or obstruction?
The read
At POD 3 with a quiet, diffusely distended abdomen and stable observations, ileus is the likely read: correct potassium and magnesium, limit opioids, decompress if vomiting persists. Colicky pain, tinkling sounds or a focal picture would push toward mechanical obstruction and a CT.
Common problems
Complications to know
early
Postoperative bleeding
Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.
late
Surgical-site infection
Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.
early
Anastomotic leak
Day 3–7: tachycardia, fever, abdominal pain, ileus that fails to resolve, or subtle deterioration that 'doesn't add up'.
early
Bile leak
Right upper quadrant pain, fever, and bilious drain output, or a patient who is simply failing to thrive after cholecystectomy.
late
Intra-abdominal abscess
Swinging fevers, malaise, and localized pain from day 5 onward, classically after perforated appendicitis.
early
Postoperative ileus
Distension, absent flatus, intolerance of diet, and quiet bowel sounds in the days after abdominal surgery.
early
Atelectasis & pulmonary complications
Low-grade fever and mild desaturation in the first 48 hours, especially after upper-abdominal incisions.
late
Venous thromboembolism
Unilateral leg swelling, or sudden dyspnoea, pleuritic pain, tachycardia, sometimes the only sign is unexplained hypoxia.
Emergencies
The calls that cannot wait
Perforated viscus
Recognise: Sudden-onset pain, a board-like abdomen, and free air under the diaphragm on the erect film or CT.
First move: Resuscitate, antibiotics, and theatre for source control: a perforation is a countdown, not a condition.
Strangulated hernia
Recognise: A tender, irreducible, tense lump with overlying skin changes and a patient becoming obstructed and toxic.
First move: Theatre without delay: strangulated bowel dies by the hour, and reduction en masse is the trap to avoid.
Massive upper GI bleed
Recognise: Haematemesis with shock: a heart rate above the systolic pressure is the arithmetic of exsanguination.
First move: Blood products by protocol, early endoscopy, and the surgical team aware from the first hour, not the last.
Anastomotic leak
Recognise: POD 5 to 7: new tachycardia, new atrial fibrillation, rising markers, or simply a patient who has stopped getting better.
First move: CT with contrast asks the question; sepsis control answers it, by drain or by relaparotomy.
Hub shaped by the Surgical Specialties Lead with the General surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.