••• CHAPTER 35^ Postoperative Care of the Gynecologic Patient^357
❍ How might postoperative prerenal oliguria be differentiated from acute renal failure?
Prerenal azotemia tends to have a low fractional excretion of sodium, usually <1%. This is calculated by:
(Urine sodium × Plasma creatinine) × 100 /(Plasma sodium × Urine creatinine).
❍ What are the indications of dialysis in the postoperative patient who develops acute renal failure?
Volume overload, hyperkalemia unresponsive to potassium binders, alteration in mental status, and a pericardial
friction rub.
❍ How should hypertensive patients who have been taking diuretic medications be managed in the
postoperative phase?
Diuretics can cause volume and electrolyte disturbances, and usually are not needed in the first 2 postoperative
days.
❍ What gynecological surgeries predispose to postoperative inability to void?
Operations involving the urethra or bladder.
❍ What surgery is associated with the majority of vesicovaginal fistulas?
Total abdominal hysterectomies for benign indications.
❍ How does a low albumin level reflect on nutritional status?
A low albumin level reflects a depletion of visceral proteins of at least 3 weeks’ duration.
❍ What protein level gives a more immediate picture of nutritional status?
The transferrin level that has a half-life of 8 to 9 days provides a more recent protein assessment.
❍ What are the indications of total parenteral nutrition?
No oral intake for 7 to 10 days, especially if nutritionally compromised.
❍ What is the most common etiology of postoperative hemorrhage arising from the vaginal vault following
hysterectomy?
Improperly ligated vaginal artery at the lateral vaginal angle.
❍ When does hemorrhage from cervical conization typically occur?
Usually in the first 24 hours, or 7 to 14 days later when the cervical sutures lose their tensile strength.
❍ How much crystalloid should be administered per milliliter of blood loss in the initial treatment of
hemorrhagic shock?
3 mL of crystalloid per l mL of blood loss.
❍ What is the most common cause of shock in the perioperative period?
Inadequate hemostasis related to hemorrhage.