Post Op. 2 Flashcards
Low urinary output in the presence of normal perfusing pressure suggests? 2 ways to Diagnose?
Fluid deficit or acute renal failure
- Fluid challenge (500 mL of IV fluid) – dehydrated patients will increase doing output, patients with acute renal failure will not
- Measure urinary sodium – under 20 mEq/L in patient with functioning kidneys, over 40 mEq/L in pt with real failure
- FENA - renal failure if over 1%
Postoperative urinary retention – management?
Intermittent catheterization at six hours postop if no spontaneous bleeding
Foley indicated at second catheterization
Paralytic ileus? Prolonged by?
Absent bowel sounds and no passage of gas after abdominal surgery
Prolonged by hypokalemia
In postoperative patient, when to consider mechanical bowel obstruction instead of paralytic ileus? Diagnosed by? Management?
Paralytic alias not resolving after 5-7 days
- X-ray shows dilated loops of small bowel and air fluid levels
- CT scan shows transition point
Surgical intervention
Wound dehiscence – generally seen when? Signs? Management?
POD 5; pink fluid soaking the dressings (peritoneal fluid)
Non-emergent Reoperation to prevent or treat a ventral hernia
Ogilvie syndrome? Demographic? Symptoms? Imaging shows? Management?
Paralytic alias of the colon
Elderly sedentary patients who have become further immobilized
Large abdominal distention without tenderness
Imaging shows massively dilated colon
- Thorough mechanical obstruction radiographically/endoscopically
- IV neostigmine to restore colonic motility
Evisceration? Typical patient? Management?
Complication of wound dehiscence where skin opens up and abdominal contents brush out
Patient with wound dehiscence coughs, strains, gets out of bed
- Cover wounds in large sterile dressings soaked with saline
- Emergency abdominal closure
Complications of G.I. Fistulas?
Pooling – may lead to sepsis. Requires complete drainage
Fistulas will heal naturally unless?
FII-TIDE Foreign body Infection Irradiated tissue Tumor IBD Distal obstruction Epithelialization