Surgery

Question 1

Features of post-operative ileus

Answer 1

Failure to pass flatus or faeces
Sensation of bloating + distension
Nausea + vomiting (or high NG output)
Abdominal distension + absent bowel sounds on examination

Question 2

Patient risk factors for post-op ileus

Answer 2

Increased age
Electrolyte derangement
Neurological disorders
Use of anti-cholinergic medication

Question 3

Surgical risk factors for post-op ileus

Answer 3

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

Question 4

Management of post-op ileus

Answer 4

NBM
IV fluids with strict fluid balance
NG tube - free drainage, regular aspirations
Daily bloods - correct electrolyte abnormalities + monitor for AKI
Encourage mobilisation
Reduce opiate analgesia