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Surgery

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Thyroid & Adrenal

Question
61 out of 99
 

On the second day after repair of coarctation of the aorta, a patient develops abdominal pain with some tenderness, correct management for the patient problem is most likely to include.



A Antibiotic agents
B Antacids

C Steroids
D Antihypertensive drugs

Ans. D Antihypertensive drugs (Ref: Schwartz :Principles of surgery 5th edition page no.787-792)

a. The characteristic features of coarctation of the aorta were clearly outlined by a bott in1928.

b. It is a common congenital malformation in 10-15% of the cases of congenital heart disease.

c. It is more common in males, ratio being 3:1.

d. An ideal age for the operation is between 3 & 4 years.

e. Most children do not have or hve minimal symptoms despite severe hypertension.

f. Head-ache, epistaxis and leg –fatigue may be the presenting symptoms.

g. Hypertension may rebound paradoxically in the postoperative period after repair of coarctation of the aorta, with diastolic pressures exceeding 110 mmHg.

h. Apparently, the hypertension is related to sudden perfusion of visceral arteries that previously were functioning with lower perfusion pressure.

i. If untreated the hypertension can produce significant abdominal pain or even intestinal necrosis, which is probably attributable to a mesenteric arteritis.

j. The condition will almost always resolve with the use of antihypertensive medication, usually reserpine.

k. If the condition is treated promptly serious complications virtually are unknown.

l. However residual hypertension is common in patients operated after the age of the 5 years.

m. The most feared complication is paraplegia.

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