Audio_Postop_Fp_7

CHIEF COMPLAINT: Rash on the abdomen 1 week after gastric bypass surgery.

HISTORY: The patient had laparoscopic gastric bypass exactly 1 week ago and complains of a rash on his abdomen which has spread to his upper medial thighs. Otherwise, he feels well. He has no fever, no problems drinking, no nausea and vomiting. He has had minor diarrhea.

PHYSICAL EXAMINATION: He looks absolutely well. He has a temperature of 36, blood pressure 120/70, pulse 72, respirations 16. His abdomen has a rash; it appears like contact dermatitis. I notice that his dressings are soiled and are still on his abdomen despite our advice with postoperative instructions which is written and oral to remove the dressings and shower. He has not done so because the hospital nurses have given different instructions. I removed the dressings. I removed the staples. There is no rash, interestingly, under the dressings.

IMPRESSION AND PLAN: As this appears like a contact dermatitis type of rash and is definitely not a cellulitis, I did not provide any antibiotics. I advised him to take Benadryl, to shower and wash with a mild soap, and apply over-the-counter hydrocortisone cream as needed for symptomatic relief. He will be back to see us in 1 week. He stopped his Mellaril and Advil, which I think is a good idea.