Post Op. 2

Question 0

Low urinary output in the presence of normal perfusing pressure suggests? 2 ways to Diagnose?

Answer 0

Fluid deficit or acute renal failure

1. Fluid challenge (500 mL of IV fluid) – dehydrated patients will increase doing output, patients with acute renal failure will not
2. Measure urinary sodium – under 20 mEq/L in patient with functioning kidneys, over 40 mEq/L in pt with real failure
3. FENA - renal failure if over 1%

Question 1

Postoperative urinary retention – management?

Answer 1

Intermittent catheterization at six hours postop if no spontaneous bleeding

Foley indicated at second catheterization

Question 2

Paralytic ileus? Prolonged by?

Answer 2

Absent bowel sounds and no passage of gas after abdominal surgery

Prolonged by hypokalemia

Question 3

In postoperative patient, when to consider mechanical bowel obstruction instead of paralytic ileus? Diagnosed by? Management?

Answer 3

Paralytic alias not resolving after 5-7 days

1. X-ray shows dilated loops of small bowel and air fluid levels
2. CT scan shows transition point

Surgical intervention

Question 4

Wound dehiscence – generally seen when? Signs? Management?

Answer 4

POD 5; pink fluid soaking the dressings (peritoneal fluid)

Non-emergent Reoperation to prevent or treat a ventral hernia

Question 5

Ogilvie syndrome? Demographic? Symptoms? Imaging shows? Management?

Answer 5

Paralytic alias of the colon

Elderly sedentary patients who have become further immobilized

Large abdominal distention without tenderness

Imaging shows massively dilated colon

1. Thorough mechanical obstruction radiographically/endoscopically
2. IV neostigmine to restore colonic motility

Question 6

Evisceration? Typical patient? Management?

Answer 6

Complication of wound dehiscence where skin opens up and abdominal contents brush out

Patient with wound dehiscence coughs, strains, gets out of bed

1. Cover wounds in large sterile dressings soaked with saline
2. Emergency abdominal closure

Question 7

Complications of G.I. Fistulas?

Answer 7

Pooling – may lead to sepsis. Requires complete drainage

Question 8

Fistulas will heal naturally unless?

Answer 8

FII-TIDE
Foreign body
Infection
Irradiated tissue
Tumor 
IBD
Distal obstruction
Epithelialization