World Anaesthesia Issue 17

Issue 17 (2003) Article 13: Page 1 of 1

SELF ASSESSMENT

Dr Rob Law,
Shrewsbury , UK

Question 1

A 70 year-old patient who is a heavy smoker with chronic obstructive pulmonary disease presents to the emergency department. He has had no previous surgery and his only medication is inhalers for his chest. He manages to walk about 2 miles a day and is otherwise well excepting for recent loss of weight. He gives a four-day history of mild abdominal pain, anorexia and constipation with increasing abdominal pain and vomiting over the last two days.

On examination:

General examination:	Pale. Apyrexial. Dry mouth. 70kg.
Cardiovascular:	Pulse 120 (sinus) B.P. 100/60 Cold peripheries.
Respiratory:	Slightly tachypnoeic. Chest clear.
Abdominal:	Very distended. Localised tenderness. No hernia. Increased bowel sounds.

Special investigations:

Chest Xray:	Chronic obstructive pulmonary disease. No air under the diaphragm.
Abdominal Xray:	Dilated colon and small bowel.
Full blood count:	Hb 9.0g/dl, WCC 13 x 10⁹/l, Plts 600 x 10/l.
Biochemistry:	Creatinine 100 mmol/l, urea 15 mmol/ l, Na 130mmol/l, K 3.5mmol/l
Arterial blood gas:	pH 7.3, pCO₂ 4, pO2 8, BE-8 (breathing air)

The surgeon notifies you of this case, saying that he needs to do a laparotomy and that he suspects bowel obstruction due to a colonic malignancy. Discuss in detail the anaesthetic approach to this case and explain the pathophysiology and physiology likely to be responsible for the blood gas result.

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