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Chapter 5. Postoperative Complications

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All of the following are true of respiratory complications, except

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A. They are common after chest procedures, but rare after abdominal operations

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B. They are the most common single cause of morbidity after major surgical procedures

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C. They occur more commonly in the elderly, smokers, and obese patients

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D. Predisposing factors can be moderated by preoperative and postoperative activities

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E. They include atelectasis, pneumonia, aspiration, and pulmonary emboli

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A. They are common after chest procedures, but rare after abdominal operations.

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A 64-year-old woman is 12 days after total abdominal hysterectomy for benign disease. She returns to the emergency room with nausea and vomiting, and has an abdominal examination that is distended, but not very tender, and her wound is clean. An abdominal series shows some dilated loops of small bowel but no free air.

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A. She should return to the operating room as soon as is practical for lysis of adhesions.

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B. The abdominal focus of her symptoms rules out chest problems such as pneumonia.

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C. Her initial management can include intravenous hydration and nasogastric suction.

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D. The presence of dilated loops of bowel on radiographs rules out the possibility of a benign ileus.

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E. Both A and C are true.

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C. Her initial management can include intravenous hydration and nasogastric suction.

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A 82-year-old woman underwent a laparoscopic hand-assisted sigmoid colectomy with diverting loop ileostomy 5 days ago for a rectal cancer after neoadjuvant radiation therapy. She is tolerating a regular diet and her ileostomy is healthy and functional. The nurses report that she is somewhat somnolent, and has not urinated during the past two shifts. Which is the most likely cause of her anuria?

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A. Acute renal failure

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B. Inadequate fluid resuscitation in the operating room

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C. High ileostomy output with inadequate postoperative replacement

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D. Low cardiac output

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E. Urinary retention

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C. High ileostomy output with inadequate postoperative replacement

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A 30-year-old man is 16 hours s/p emergency laparotomy for blunt abdominal trauma from a motor vehicle accident. His spleen was removed, a liver laceration was managed with sutures and topical procoagulants, ...

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