Other Post Op Complicaitons

Question 1

What are the two major differentials for post op chest pain?
How to make the diagnosis for each?
How to treat?

Answer 1

MI and PE
Troponin and EKG, US and spiral CT
Cath lab, heparin to warfarin bridge

Question 2

4 differentials for post op altered mental status?

How to treat each one?

Answer 2

electrolytes out of wack, fix sodium and calcium
Sundowning, elderly get bad at night, give atypical antipsychotics
Hypoxemia, ARDS, incubate and give o2
DT because of alcohol withdrawal, give benzo

Question 3

How do we diagnose post op ileus?

How to treat?

Answer 3

KUD, the entire bowel (small and large) is expanded based on no stool or gas on day 1 or 2
Fluids, potassium, and get them to move around

Question 4

What does the patient look like with post op obstruction?
How to diagnose?
How to treat?

Answer 4

Still no stool or gas day 5 or 6
KUD, proximal dilation prior to obstruction
Surgery

Question 5

What is the most common cause of the obstruction post op?

Answer 5

Adhesions

Question 6

How do we define Ogilvie syndrome?

Answer 6

Ileus of just the colon in elderly

Question 7

What is the time frame for delirium tremens?

Answer 7

48-72 hours

Question 8

How do we define dehiscence? What is the complication because of it?

Answer 8

Failure of fascia to close

Hernia

Question 9

How do we define evisceration? Complication?

Answer 9

Failure of the entire wound to close, skin and fascia

Loops of bowel pops out

Question 10

What is the mnemonic for things that causes fistula?

Answer 10

FRIEND

Foreign body, radiation, inflammation, epithelization, neoplasm, distal obstruction

Question 11

What are 4 types of visceral abdominal pain? What is the 5th type to always think of?

Answer 11

Obstructive, inflammation, perforation and ischemic and referred

Question 12

How do we best describe obstructive pain?
What is absent?
Two examples?

Answer 12

Colicky, comes and goes.
No fever or leukocytes
Gall stones and kidney stones

Question 13

How do we best describe inflammatory pain?
Two things present?
2 examples?

Answer 13

Constant
Fever and leukocytes
Inflammation of gall bladder and pyelonephritis

Question 14

Best describe pain from perforation?

2 examples?

Answer 14

Constant and sick as crap

Peptic ulcer and bowel

Question 15

In the angry robot, what is RUQ differentials?
LUQ?
RLQ?
LLQ?
Supra pubic?
Epigastric?
Middle of the robot that is kind of overlapping?

Answer 15

Lung, diaphragm, liver, GB
Lung, diaphragm, spleen
Kidneys, ureter, testes, ovary, colon, appendix
Same but then colon, diverticula
Bladder, uterus
Heart, aorta, esophagus, pancreas, stomach
Constipation, DKA, and Mess-enteric ischemia

Question 16

Rule to go to surgery for abdominal pain?

Answer 16

If they are peritoneal, they go to surgery

Involuntary guarding and rebound tenderness. Don’t need imaging.

Question 17

What image for each quadrant?

Answer 17

RUQ US

CT for other quadrants