Case One Postoperative laproscopic abdominal surgery complications : y Bleeding y Infection y N/V y DVT (Swelling, warm to touch, painful) y Complications

associated with CO2 insufflation y Too much/too little output²No urinary output/BM or diarrhea. y Medication to control output, infection, N/V, etc can be administered. y Ambulations/ROM exercises to prevent DVT. y Frequent assessment and vital sign/pain y 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).

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