Viva 5

You are asked to see a 72 year old man who is 5 days post elective left hemicolectomy for cancer. His co-morbidities include COPD, ischaemic heart disease and rheumatoid arthritis.

On assessment he is drowsy but responsive to voice.  He is poorly perfused, HR =120, BP = 100/60. His heart sounds and lung fields are normal; his abdomen is diffusely tender and distended.  He has intravenous access, and has been commenced on fluids and O2 .

Please outline your most likely diagnosis and a differential diagnosis for this patient’s deterioration.

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.