A 52-year-old gravida 3 para 3 woman underwent abdominal hysterectomy for uterine fibroids. Her medical history is significant for 3 spontaneous vaginal deliveries in her 20s, hypertension, obesity, depression, and osteoarthritis. Past surgical history is significant for appendectomy at 20 years of age and tonsillectomy and 9 years of age. Medications include a calcium-channel blocker and selective serotonin reuptake inhibitor, along with acetaminophen as needed for arthritis pain. She does not smoke.
Following an uncomplicated surgery, she was transferred from the postanesthesia unit to the regular floor. On postoperative day 1, it was noted that her urinary output was decreasing. During each of the past 3 hours, she has voided 18 mL/hour.
Vital signs are P: 100; BP: 90/55; RR: 18; T: 99.9°F; and oxygen saturation: 99% on 3 L via nasal cannula.
On physical examination, she is awake, alert, and oriented. Lungs are clear to auscultation, and bowel sounds are hypoactive. S1 and S2 heart sounds are present. No jugular venous distension is noted. Abdomen is soft. Dressings are dry. There is decreased turgor of skin and dry mucous membranes. Laboratory results are pending.
What is the most likely etiology for the decreased urinary output?
- ureteral obstruction
- decreased intravascular volume
- cardiogenic failure
- acute hemorrhage into the abdominal compartment
This question appears in Med-Challenger OBGYN Exam Review with CME
Try for free and save. Ace your exams and meet your CME/MOC requirements for just $26 a month!
