Case One

Postoperative laproscopic abdominal surgery complications :

 Bleeding
 Infection
 N/V
 DVT (Swelling, warm to touch, painful)
 Complications associated with CO2 insufflation
 Too much/too little output—No urinary output/BM or diarrhea.
 Medication to control output, infection, N/V, etc can be administered.
 Ambulations/ROM exercises to prevent DVT.
 Frequent assessment and vital sign/pain
 Watch and record BM/urinary output

Orthoscopic vital sign is indicated when the patient feels dizzy. As increase in systolic of
more than 10 and an increase in diastolic of more that 20 and an increase in HR of more
than 20%.

Mechanical vs non mechanical bowel obstrution

Mechanical obstructions in short means there is a mechanism blocking the intestines
(Scar tissue, tumors (very rare), twisted intestines (Volvulus), Intestines that telescope
into itself (Intussusception), Inflammatory disease such as Chrohn’s disease, Hernias,
Fecal impaction (stools that block the intestines), Foreign bodies).
Non-mechanical bowel obstructions normally has to do with the peristalses of the
intestines. Peristalses is the wave-like contractions that help the bowels move stools
forward. If these contractions become interrupted or paralyzed, the intestines become
obstructed (kidney and lung diseases, infections, low potassium levels, decreased blood
flow and certain medications).

Pathophysiology of ileus
Ileus is thought to be caused by disruption of the normal neuro-hormonal regulation of
the gut. In health, various local neuronal reflexes and chemical mediators maintain gut
function and motility. Putative factors that disrupt this include: (Neurogenic: Inhibitory
sympathetic reflexes; lack of gut stimulation; Inflammatory mediators; Anaesthesia;
Analgesic drugs (e.g. opiates).

Postoperative ileus is thought to result from inflammation, deranged neural input, or

medications taken in conjunction with surgery. Large-volume intraoperative fluid
resuscitation and prolonged procedure time associated with extensive dissection may
contribute to the development of these events. Inflammation is mediated by the release of
macrophages, which orchestrate other intermediaries including nitric oxide,
prostaglandins, and cytokines. The presence of these inflammatory mediators inhibits
smooth-muscle contraction and decreases the normal propulsive activity of the intestine
(SXS: Anorexia• Abdominal distention• Abdominal pain• Nausea/vomiting• Delayed
passage of flatus/stool• Belching• Hiccups).