Urgent Care Management of the Patient With Prior Bariatric Surgery

A 32-year-old woman presents with nausea and vomiting…

• She had 2 episodes of vomiting today with no hematemesis. She thinks she may have a “stomach bug“ but denies diarrhea or ill contacts.
• She is afebrile and her vital signs are normal.
• She had gastric sleeve surgery 2 months ago.
• Given her history, you wonder if her nausea and vomiting are related to her recent surgery…

A 58-year-old woman presents with generalized cramping, abdominal pain, nausea, and bloating that started today...

• She had Roux-en-Y gastric bypass surgery 2 years ago.
• The patient reports having bowel movements, but they seem to be fewer than normal. Polyethylene glycol 3355 has not helped, and she thinks this is “gas.” She is drinking less and thinks this could be constipation and dehydration.
• She is afebrile and tachycardic at 112 beats/min.
• You consider if this patient should be sent to the hospital for further evaluation…

A 43-year-old man presents with shortness of breath and pleuritic chest pain that began earlier today while at rest…

• He has a history of laparoscopic Roux-en-Y gastric bypass surgery 2 weeks ago in Mexico. He returned 5 days ago after a prolonged flight.
• The pain is worse with deep inspiration and occurs more on the right side. The patient denies cough, fever, or calf tenderness.
• His BMI is 42.0 (clinically obese) and he also has a history of hypertension.
• His vital signs are: temperature, 98.7˚F; heart rate, 116 beats/min; blood pressure, 134/82 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 92% on room air.
• This patient has many risk factors, so you wonder what the best course of action will be…