g a s t r o i n t e s t i n a l

Question 1

what are the gastrointestinal complications post op

Answer 1

anastomotic leak

bowel adhesions

incisional hernia

post operative constipation

post operative ileus

anaesthetics

Question 2

what is post operative ileus

Answer 2

deceleration or arrest in intestinal motility following surgery. It is classified as a functional bowel obstruction

Question 3

ddx of post operative ileus

Answer 3

an abdominal collection

anastomotic leak (as pus or faeces will irritate the bowel and often cause it cease functioning

Question 4

complications of post op ileus

Answer 4

lengthen hospital stay and increased hospital costs;

Question 5

patient rx factors of post operative ileus

Answer 5

Increased age
Electrolyte derangement (e.g. Na+, K+ and Ca2+ derangement)
Neurological disorders (e.g. Dementia or Parkinson’s Disease)
Use of anti-cholinergic medication

Question 6

surgical rx of post op ileus

Answer 6

Use of opioid medication
Pelvic surgery
Extensive intra-operative intestinal handling
Peritoneal contamination (by free pus or faeces)
Intestinal resection

Question 7

clinical features of post op ileus

Answer 7

Failure to pass flatus or faeces
Sensation of bloating and distention
Nausea and vomiting (or high NG output)

On examination, there will be abdominal distention and absent bowel sounds

(whereas in mechanical obstruction there are classically ‘tinkling’ bowel sounds present)

Question 8

investigations of post op ileus

Answer 8

routine bloods should be taken, including FBC and CRP (to check inflammatory markers), and U&Es (as fluid shifts can occur within the adynamic bowel leading to AKI).

Electrolytes, including Ca2+, PO₄³⁻, and Mg2+, should also be checked and corrected accordingly

A CT scan abdomen and pelvis (often with oral contrast) -confirm dx and rule out any intra-abdominal collections or anastomotic leaks.

Question 9

management of post op ileus

Answer 9

(NBM), ensuring adequate maintenance intravenous fluids

Start a strict fluid-balance chart to monitor input-output

Daily bloods, including electrolytes

Correct any electrolyte abnormalities and monitor for acute kidney injury

Encourage mobilisation as tolerated

Reduce opiate analgesia and any other bowel mobility reducing medication

Question 10

prophylactic measures for post op ileus

Answer 10

Minimise intra-operative intestinal handling

Avoid fluid overload (causing intestinal oedema)

Minimise opiate use

Encourage early mobilisation

Question 11

categorises of constipation post op

Answer 11

Physiological – due to factors such as a low fibre diet, poor fluid intake, or low physical activity

Iatrogenic – medications such as opioid analgesia, anticonvulsants, iron supplements, or antihistamines

Pathological – such as hypercalcaemia, hypothyroidism, or neuromuscular disease

Functional – from painful defecation (such as anal fissures)

Question 12

constipation on axr

Answer 12

faecal matter is opaque white, surrounded by black bowel gas

Question 13

management of constipation

Answer 13

1. adequate hydration and sufficient dietary fibre, treating the underlying cause, and encouraging early mobilisation.
2. laxatives

Question 14

constipation prophylaxis

Answer 14

Prophylactic stimulant laxatives, such as senna, should be used for patients on opioid analgesia, especially in the elderly.

Question 15

incisional hernia

Answer 15

incisional hernia is the protrusion of the contents of a cavity (usually the abdomen) through a previously made incision in the compartment’s wall.

3-6 months post op

Question 16

incisional hernia risk factors

Answer 16

emergency surgery

bmi greater than 25

midline incision

post op wound infection

dm

increasing age

current smoker

Question 17

clinical features of incisional hernia

Answer 17

reducible, soft and non-tender swelling at or near the site of a previous surgical wound. If the hernia is incarcerated, it can become painful, tender, and erythematous

mass is palpable at or near the site of the surgical incision, which may be reducible into the abdominal cavity

check for clinical features and ischaemia

Question 18

imaging for incisional hernia and mnx

Answer 18

ct imaging

surgery

Question 19

management of bowel adhesion

Answer 19

1. tube decompression
2. nil-by-mouth, prescribed intravenous fluids, and provided with adequate analgesia.
3. surgery