Lesson 1Follow-up planning, reassessment for definitive elective surgery if indicated, and documentation for outpatient handoverThis section explains how to plan follow-up after ulcer surgery, reassess the need for definitive elective procedures, and create clear documentation and discharge summaries that support safe outpatient continuity of care.
Scheduling early and long-term surgical follow-upCriteria for considering definitive elective surgeryKey elements of a safe discharge summaryCommunication with primary care and gastroenterologyPatient education for warning signs after dischargeLesson 2Nutrition and mobilisation: NPO duration, nasogastric tube indications, timing of enteral feedingThis section addresses postoperative nutrition and mobilisation, including NPO duration, nasogastric tube indications, timing and route of enteral feeding, and protocols that promote early ambulation and enhanced recovery.
Criteria to discontinue nasogastric decompressionAssessing readiness to start oral intakeStepwise advancement of postoperative dietEnteral versus parenteral nutrition decisionsEarly mobilisation and physiotherapy protocolsLesson 3Recognition and management of late complications: fistula, adhesive obstruction, recurrent ulcerationThis section reviews late postoperative complications after ulcer surgery, including fistula, adhesive obstruction, and recurrent ulceration, focusing on clinical recognition, diagnostic workup, and stepwise medical, endoscopic, or surgical management.
Clinical features of postoperative enterocutaneous fistulaEvaluation and imaging of adhesive small bowel obstructionManagement of chronic fistula output and nutritionDiagnosis of recurrent ulceration after surgeryEndoscopic and surgical options for recurrent ulcersLesson 4Analgesia plans including multimodal strategies and opioid-sparing optionsThis section presents multimodal postoperative analgesia strategies, emphasising regional techniques, non-opioid adjuncts, opioid-sparing regimens, monitoring for side effects, and tailoring pain control to enhance recovery and mobilisation.
Pain assessment scales and documentationUse of paracetamol and NSAIDs safelyRegional blocks and epidural analgesia optionsAdjuvant agents such as gabapentinoidsDesigning opioid-sparing analgesia protocolsLesson 5Immediate postoperative monitoring in PACU/ICU: parameters, frequency, and escalation triggersThis section outlines structured monitoring in PACU and ICU after ulcer surgery, defining vital parameters, pain and sedation assessment, monitoring frequency, and clear triggers for escalation, rapid response activation, or transfer to higher care.
Standard PACU monitoring set and documentationHaemodynamic and urine output targets after surgeryRespiratory monitoring and pulse oximetry strategyPain, sedation, and delirium assessment toolsEscalation triggers and rapid response activationLesson 6Early postoperative investigations: labs, radiographs, CT indications for suspected leak or abscessThis section explains when and how to use labs, radiographs, and CT after ulcer surgery to detect leaks or abscesses early, interpret key findings, and choose appropriate escalation, drainage, or reoperation strategies.
Baseline and serial postoperative laboratory panelsUse of plain radiographs and contrast swallow studiesCT indications for suspected leak or abscessImaging signs of anastomotic leak and collectionsAlgorithm for escalating from labs to advanced imagingLesson 7Infection prevention and antibiotic stewardship: duration, de-escalation based on culturesThis section reviews infection prevention and antibiotic stewardship after ulcer surgery, covering perioperative prophylaxis duration, culture-guided de-escalation, monitoring for failure, and strategies to limit resistance and C. difficile.
Appropriate duration of surgical prophylaxisEmpiric therapy for suspected intra-abdominal sepsisCulture collection and interpretation principlesAntibiotic de-escalation and stop criteriaMonitoring for C. difficile and resistant organismsLesson 8Thromboprophylaxis, glycaemic control, and wound care best practicesThis section details best practices for thromboprophylaxis, glycaemic control, and wound care after ulcer surgery, including risk stratification, pharmacologic and mechanical measures, glucose targets, and strategies to prevent wound infection.
VTE risk assessment and prophylaxis selectionTiming and dosing of pharmacologic anticoagulationMechanical prophylaxis and mobilisation protocolsPerioperative glycaemic targets and insulin regimensWound dressing choices and infection preventionLesson 9Recognition and management of early complications: leak, intra-abdominal abscess, sepsis, respiratory complicationsThis section covers recognition and management of early complications such as anastomotic leak, intra-abdominal abscess, sepsis, and respiratory events, emphasising early warning signs, diagnostic pathways, resuscitation, and timely source control.
Clinical red flags for anastomotic leakSepsis bundles and haemodynamic resuscitationDiagnosis and drainage of intra-abdominal abscessPrevention and treatment of postoperative pneumoniaCriteria for reoperation versus percutaneous drainageLesson 10Long-term medical management of peptic ulcer disease: H. pylori testing and eradication, PPI therapy, NSAID avoidance, smoking and alcohol counsellingThis section focuses on long-term medical management of peptic ulcer disease, including H. pylori testing and eradication, PPI strategies, NSAID risk mitigation, and counselling on smoking, alcohol, and adherence to therapy.
Indications and methods for H. pylori testingStandard and rescue H. pylori eradication regimensOptimising PPI dosing and tapering strategiesManaging NSAID and antiplatelet exposureLifestyle counselling on smoking and alcohol
