On the third post-operative day a patient has abdominal distension, vomiting and absent bowel sounds without abdominal pain, with low potassium. What is the most likely diagnosis and initial management?
Answer and explanation
Correct answer: A. Paralytic ileus, managed with nil by mouth, intravenous fluids and electrolyte correction
- Step 1: Painless distension with absent bowel sounds and hypokalaemia points to functional failure of peristalsis. Step 2. Treatment is supportive: rest the bowel, replace fluid and potassium and treat the causes. Answer: Paralytic ileus, managed with nil by mouth, intravenous fluids and electrolyte correction. Why not the others: Appendicitis is not expected after the main operation. Laxatives could cause harm in obstruction. Ischaemia would give severe pain out of proportion and would need urgent investigation.
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