Post OP Problems

Option List:
A. Perineal hematoma
B. Broad ligament hematoma
C. Subrectus hematoma
D. Wound hematoma
E. Supravgainal Hematoma
F. Infravginal Hematoma
G. Paravgainal Hematoma
H. Vault hematoma
I. Vulval hematoma
J. Atonic postpartum Haemorrhage
K. Traumatic postpartum Haemorrhage
L. Perianal hematoma
For each scenario described below choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all. 

1. Ms,Mary 65 year-old woman had a  vault prolapse following abdominal hysterectomy sacrospinous fixation performed. She presented with pain  in perineum and  buttock .pain score is 8/10 .

2. Ms. Tina , A 38 year-old woman was referred by the Gp with a swelling underneath scar.she underwent elective Caesarean section for persistent breech presentation with multiple attempts of failed ECV her .BMI is 40kg/m2.she was on therapeutic dose of cold and as she has thrombophilia.on examination skin is Bluish tinge around right edge of scar .swelling and induration present .minimal oozing  of brownish blood from right edge of scar.

3. Mrs., Laurie , A 60 year-old woman had a vaginal hysterectomy performed for pelvic organ prolapse. She complained of a constant pressure per vaginum, a constant urge and frequency although minimal urine is passed.

4. A 30-year old-woman collapsed on the ward following an uneventful Kjelland's forceps delivery. Forceps was drop persistent occipto transverse position  .on examination she ha pulse rate of 120bpm.blood pressure is 80/60 mm of Hg .abdomen is diffusely tender  , uterus well contracted and retracted , no bleeding noted in vagina. Her Hb dropped from 13 to 7 gm%

5. A 28-year-old woman had an episiotomy performed , delivery was uneventful .She has complains of severe pain in perineum not relieved by opioid analgesia  ,she feels tenesmus. she wants to  go to toilet repeatedly as she has urge to pass stool

Option List:
A. Conservative management with Iv fluids and correction of electrolyte imbalance and Nil by mouth
B. Urgent colonic decompression with rectal flatus tube
C. Involve Multidisciplinary action
D. Immediate surgeon review
E. Iv fluids, analgesia, correction of electrolyte imbalance
F. Iv fluids, analgesia, correction of electrolyte imbalance and iv neostigmine
G. Immediate laparotomy
H. Iv neostigmine
I. Urgent surgical review and immediate laprotomy
J. Stop opioid analgesia , conservative management with Iv fluids and correction of electrolyte imbalance and nil by mouth
K. Reassuarnce and send her home
L. Nasogastric tube aspiration
M. Passing flatus tube
N. Immediate laparoscopy
O. Admission to HDU and correction of electrolyte imbalance
For each scenario described below choose the SINGLE most appropriate management  for the post cesarean woman with bowel complications from the above list of options . Each option may be used once, more than once, or not at all. 

6. Mrs. x underwent cesarean section at full dilatation .she has developed progressive abdominal distension in day 2, on examination pulse -110bpm, blood pressure is 110/70m. Of Hg , temperature is 36,5c  Abdomen -distended, bowel sound sluggish, no guarding nor rigidity  Abdomen X-ray shows distended large bowel particularly caecum which is measuring 13cm

7. Mrs. x underwent cesarean section at full dilatation .she has developed progressive abdominal distension in day 2, on examination pulse -110bpm, blood pressure is 110/70m. Of Hg , temperature is 36.5c. Abdomen -distended, bowel sound sluggish, no guarding nor rigidity. Abdomen X-ray shows distended large bowel particularly caecum which is measuring 11cm

8. Mrs. x underwent cesarean section at full dilatation .she has developed progressive abdominal distension in day 2, on examination pulse -110bpm, blood pressure is 110/70m. Of Hg , temperature is 36.5c Abdomen -distended , bowel sound sluggish , with guarding and rigidity noted Abdomen X-ray shows distended large bowel particularly caecum which is measuring 11cm

9. Mrs. x underwent cesarean section at full dilatation .she complains of pain and abdominal distension  after8hrs of surgery . History of anorexia and vomiting noted . Unable to tolerate oral fluids , she is on opioid analgesia .on examination pulse - 80bpm , blood pressure is 110/70m. Of Hg , temperature is 36.5 C.  Abdomen -soft sluggish bowel sounds, distended ,no guarding nor rigidity. Abdomen X ray - gaseous distension  of both small and large bowel .