Common tests & procedures
How is small bowel obstruction treated? 1 Hospitalization: Patients with an intestinal obstruction are hospitalized. ... 2 Anti-emetics: Medications may be required to relieve nausea and vomiting. 3 Surgery: If the small intestine is completely blocked or strangulated, surgery may be needed. ...
What is the treatment for small bowel obstruction?
In one chart review of 290 patients admitted with small bowel obstructions, about 20% were managed without an NG tube. The use of an NG tube was associated with worse outcomes across the board: longer time to resolution, longer length of stay, and a higher complication rate.
Do NG tubes improve outcomes for small bowel obstructions?
These anecdotes are powerful, and definitely shouldn’t be ignored, but anecdotes do have a way of distorting truth. (We only share the worst stories. I have seen hundreds of patients with bowel obstructions, and have never seen anything like that.
Should we ignore anecdotes about bowel obstruction?
Diagnosis of acute small bowel obstruction. The diagnosis of majority of cases of bowel obstruction can be made based on clinical presentation and initial plain radiograph of the abdomen. Luminal contrast studies, computed tomography (CT scan), and ultrasonography (US) are utilized in select cases.
How is small bowel obstruction diagnosed?
How do you know if your small bowel obstruction is resolved?
Usually, a small bowel obstruction resolves after a few days. When a patient becomes less bloated, starts to pass gas, and has a bowel movement, the tube is removed and the patient is allowed to eat and drink. If the patient is not better, then operative intervention may be necessary.
Can NG tube clear a bowel obstruction?
Most bowel obstructions are partial blockages that get better on their own. The NG tube may help the bowel become unblocked when fluids and gas are removed. Some people may need more treatment. These treatments include using liquids or air (enemas) or small mesh tubes (stents) to open up the blockage.
How long does it take for small bowel obstruction to resolve?
CONCLUSION: With closely monitoring, most patients with small bowel obstruction due to postoperative adhesions could tolerate supportive treatment and recover well averagely within 1 week, although some patients require more than 10 days of observation.
What assessment findings are expected with a small bowel obstruction?
The patient with a small bowel obstruction will usually present with abdominal pain, abdominal distension, vomiting, and inability to pass flatus. In a proximal obstruction, nausea and vomiting are more prevalent. Pain is frequently described as crampy and intermittent with a simple obstruction.
How do you confirm placement of NG tube?
Auscultation is most often used at the bedside to check for appropriate placement of a nasogastric tube. Sound generated by air blown through the tube is used to determine tube placement in the gastrointestinal tract.
Why do you insert a nasogastric tube for a bowel obstruction?
Nasogastric tubes are part of the standard of care in treating intestinal obstruction and can also be used to provide nutritional support. They are most common in surgical patients but are useful in any patient population where gastric decompression or nutritional support is necessary.
Can a bowel obstruction be cleared without surgery?
An intestinal obstruction is painful and potentially dangerous, and typically requires hospital care. However, you won't necessarily need surgery. Many blockages can be resolved with a non-invasive procedure, and patients often never have a recurrence.
How do you know when faecal impaction has cleared?
If appears in your child's poo within 24 hours the impaction has cleared. What happens after the impaction has been treated? When your child has been passing type 7 poos with no lumps the laxative dose will be reduced. This may be done immediately, or it may be done gradually.
Is small bowel obstruction curable?
In most cases, bowel obstruction is treatable.
What are the treatment goals of the care for a patient experiencing an intestinal obstruction?
Hospitalization: Patients with an intestinal obstruction are hospitalized. Treatment includes intravenous (in the vein) fluids, bowel rest with nothing to eat (NPO), and, sometimes, bowel decompression through a nasogastric tube (a tube that is inserted into the nose and goes directly to the stomach).
What initially is the primary concern when a patient is found to have a bowel obstruction?
A serious and life-threatening complication of bowel obstruction is strangulation. Strangulation is more commonly seen in closed-loop obstructions. If the strangulated bowel is not treated promptly, it eventually becomes ischemic, and tissue infarction occurs.
What is the most common complication which a patient with a small bowel obstruction might experience?
A bowel obstruction, whether partial or complete, can lead to serious and life threatening conditions if left untreated. The intestine can get swollen from the trapped air, fluid, and food. This swelling can make the intestine less able to absorb fluid. This leads to dehydration and kidney failure.
What Is Small Bowel Obstruction?
Small bowel obstruction refers to a partial or complete blockage of the small intestine. If the small bowel is functioning normally, digested produ...
What Causes Small Bowel Obstruction?
There are many causes of small bowel obstruction. It may occur in people of all ages. Some of the common causes and risk factors include 1. Adhesio...
What Are The Symptoms of Small Bowel Obstruction?
Symptoms may include 1. Abdominal (stomach) cramps and pain. 2. Bloating. 3. Vomiting. 4. Nausea. 5. Dehydration. 6. Malaise. 7. Lack of appetite....
What is bowel obstruction?
Bowel obstruction describes failure of aboral progression of intestinal contents. Based on the nature, severity, location and etiology, several terms are used to describe bowel obstruction (table I).
What is the term for a large bowel obstruction?
Large bowel obstruction or disease states may be associated with or masquerade as SBO. Acute functional dilatation of the colon is referred to as “colonic pseudo-obstruction”. Acute functional small bowel dilatation is referred to as “adynamic or paralytic ileus”.
What is an acute SBO?
Significant partial or complete obstruction is associated with increased incidence of migrating clustered contractions (MCC) proximal to the site of obstruction. Such contractions are associated with abdominal cramps. With partial obstruction MCC propel intraluminal contents and allow them to pass distal to the point of obstruction. With complete unrelieved obstruction, bowel contents fail to pass distally, with resultant progressive accumulation of intraluminal fluids and distention of the proximal bowel. This eventually initiates retrograde giant contractions (RGC) in the small bowel (SB) as the first phase of vomiting. In adynamic ileus migratory motor complexes (MMC) (contractions initiated in the stomach and proximal SB almost simultaneously and propagate distally to clear the intestine of secretions and debris) and fed contractions (intermittent and irregular contractions that provide mixing and slow distal propulsion) are inhibited.
What is SBO in medical terms?
Acute small bowel obstruction (SBO) is an ever increasing clinical problem. Successful management depends on comprehensive knowledge of the etiology and pathophysiology of SBO, familiarity with imaging methods, good clinical judgment, and sound technical skills.
How old is the average person with gallstone ileus?
The diagnosis of gallstone ileus is often difficult to make. The majority of patients are elderly (average age between 65 and 75 years), and are multimorbid. Time from onset of symptoms to surgical intervention is often long, and correct diagnosis is made preoperative only in 13–60% of cases. In the SB, the site of obstruction is usually the distal ileum, and multiple stones are present in 3–15%.
How to prevent adhesions in humans?
To prevent subsequent adhesion formation various mechanical and chemical methods have been employed. Mechanical methods include plication (small bowel and mesenteric), and stenting with long intestinal tubes. In addition to failure to prevent re-obstruction, plication is time consuming and tedious, and carries the risk of injury to the bowel or mesenteric vessels. Similarly, long intestinal tubes, in addition to difficulty in positioning distal to ligament of Treitz, are not without complications, and long terms results are not adequately evaluated. Although high dose steroids with or without promethazine, antihistamines, and dextran-70 proved to reduce adhesion formation in animals, the potential for disastrous complications prevented their use in humans. A variety of other chemicals have been used to prevent adhesions with mixed results and associated significant complications. Sodium hyaluronatebased bioabsorbable membrane have been shown to reduce adhesion formation in human, but its effect on intestinal obstruction is yet to be determined (8) (Stage A).
What is the most important diagnostic test for SBO?
Plain radiograph of the abdomen is the most valuable initial diagnostic test in acute SBO. This imaging method gives information diagnostic of SBO in 50–60% of cases and provide enough information needed for clinical decision making (4, 5) (table II). In 20–30% the radiographic findings are equivocal, and in 10–20% are normal. The typical air fluid levels seen in the dilated bowel proximal to the obstruction may be absent in high SBO, closed loop obstruction or late obstruction. Low grade obstruction is difficult to assess with plain radiograph of the abdomen.
How is bowel obstruction treated?
In the hospital, your doctor will give you medicine and fluids through a vein (IV). To help you stay comfortable, your doctor may place a tiny tube called a nasogastric (NG) tube through your nose and down into your stomach.
What is NG tube?
Most bowel obstructions are partial blockages that get better on their own. The NG tube may help the bowel become unblocked when fluids and gas are removed. Some people may need more treatment.
How does stool get out of the body?
Stool passes out of the body through the opening and collects in a disposable ostomy bag. In some cases, the colostomy or ileostomy is temporary until you have recovered. When you are better, the ends of the intestine are reattached and the ostomy is repaired.
When is colostomy needed?
Surgery is almost always needed when the intestine is completely blocked or when the blood supply is cut off. You may need a colostomy or an ileostomy after surgery. The diseased part of the intestine is removed, and the remaining part is sewn to an opening in the skin.
What are the symptoms of a small bowel obstruction?
Patients presenting with abdominal pain, nausea, abdominal distention, vomiting, and/or obstipation/constipation, should be evaluated for a small bowel obstruction (SBO). Clinical signs and symptoms of SBO are in Table 1.
What is bowel compromise?
Bowel compromise:Compromised when there is ischemia or injury that has led, or may lead, to necrosis and/or perforation of the bowel wall. There is a high risk of morbidity and mortality if not treated in an expedient manner. Signs and symptoms of bowel compromise are shown in Table 2.
What is SBO in medical terms?
The diagnosis and management of small bowel obstruction (SBO) often involves multiple disciplines including emergency medicine, surgery, radiology, internal medicine, and gastroenterology. Quality of care and patient outcomes can be compromised if diagnosis and treatment are delayed. Proper and efficient disposition from the emergency department is essential for appropriate patient management. This guideline was created to help guide clinicians in the diagnosis of SBO, to help determine proper service triage and to guide management. The goal is to enhance consistency in patient management, facilitate interdisciplinary consensus, increase efficiency of care, and improve clinical outcomes. This guideline is not meant to be comprehensive; it is intended to guide the care of most patients with SBO. This guideline does not apply to medical problems that mimic bowel obstruction (eg, scleroderma, Hirschsprung-type disease, opioid induced ileus, etc.).
What is SBO consultation?
SBO patients with advanced malignancyrequire consultation with surgery, and possibly oncology and/or palliative care to guide evaluation and treatment. These patients are usually admitted to a general medicine service, with the surgery service providing consultation (unless emergent surgery is required).
What is a SBO?
Small bowel obstruction (SBO):An intrinsic, extrinsic, or endoluminal process which narrows the bowel lumen and delays the passage of luminal contents.
How is SBO diagnosed?
The diagnosis of SBO is made by history, physical exam and imaging studies. While the majority of patients will have spontaneous resolution of their SBO with non-operative management, there are a substantial number of patients who will require surgical intervention. Although it can be challenging to predict which patients will require surgical intervention, new methods such as Gastrografin studies have shown promise in this area. The diagnosis and management of SBO is largely supported by expert opinion with few randomized control trials supporting current practice.
What causes ileus motility?
Common causes include recent abdominal surgery, medications such as opiates, and electrolyte disturbances.
What is partial bowel obstruction?
Partial bowel obstruction describes a patient who has dilated bowel on imaging, has nausea and vomiting, but continues to pass flatus or even stool intermittently. A complete obstruction has all the same signs and symptoms except for passage of flatus or stool. So the difference basically boils down to obstipation.
What is small bowel feces?
Small bowel feces sign results from gradual trapping of fibrous material while allowing fluid to pass and be reabsorbed, and thus represents a more chronic process. If a patient does not have any of the three Zielinski signs of ischemic obstruction, he or she might have a chance of resolving without surgery. Great!
What is the difference between operative and nonoperative SBO?
In the operative category, I would place the obstructions that are strangulated (by adhesions, hernia, or volvulus) as well as those that will not resolve with nonoperative therapy. Nonoperative obstructions are not strangulated, and will resolve without surgery.
How many laparotomies are performed for SBO?
In the United States alone, there are an estimated 300,000 la parotomies performed annually for SBO, and about one third of these obstructions are ...
How long does it take for an abdominal X-ray to show contrast?
Abdominal X ray at 8 hours. If contrast is seen in the colon on X-ray, or if the patient passes flatus or stool while the NG is clamped, this is a “pass” and the NG is removed and diet is advanced. Hospital discharge typically happens sometime in the subsequent 24 hours.
Can nonoperative obstructions be strangulated?
Nonoperative obstructions are not strangulated, and will resolve without surgery. Let me say a quick word about the pathophysiology of bowel ischemia in the setting of bowel obstruction. On a very basic level, and obstruction that results in, or is caused by, twisting of the mesenteric vasculature (volvulus, internal hernia, ...
Should bowel obstruction be surgically treated?
So every patient who shows up with a bowel obstruction should have surgery, to prevent ischemic complications, right? Actually, more than half of patients who present with SBO resolve with nonoperative therapy. Because the most common cause of SBO is post-operative adhesions, and each subsequent exploration carries a higher risk of unintentional damage to the intestine, surgical exploration therefore should be reserved for patients who absolutely need it.
Is NG evidence based?
Like many historical medical practices, the NG was adopted well before the era of evidence based medicine. Its use was based on common sense, and some pathophysiology, but not evidence. Unfortunately, time and again in medicine common sense and physiology have led us astray.
Do NG tubes help?
So to summarize this: we have absolutely no idea if NG tubes help. There is just no quality evidence. The observational data actually suggests harm in longer hospital stays, longer time to resolution, and more complications, but the data is so weak it shouldn’t be trusted. We just don’t know. Some patients may benefit, but the observational data suggests NG tubes should not be used routinely.
Is NG tube an anachronism?
In my mind, the use of NG tubes for bowel obstruction is an anachronism. I grew up hearing about literature that said NG tubes provide no benefit, but are routinely rated as among the most painful things we do to our patients. In my mind, this was a classic example of a medical myth that had been relegated to the history of medicine, side by side with things like leeches and trephination. However, every time I admit a patient with a bowel obstruction, the issue of NG tubes is raised, so I guess we need a quick blog post.
Is the NG tube used in emergency medicine?
For the most part, I think the role of the NG tube is incredibly limited in emergency medicine. We have to recognize it’s significant harm, being one the the most painful procedures we perform on patients. In that light, there is a high burden of proof on those suggesting the practice. We need to see evidence of benefit before we subject our patients to this procedure.
Is NG better than IV?
The NG has been touted as a possible alternative to IV for rehydration in pediatrics, but considering the pain from an NG tube is rated as much higher than the pain from an IV, it seems like the NG would be the worse alternative in the vast majority of cases.
Is a NG tube good for hydration?
The NG is occasionally an useful route for medication administration, and even hydration, but the risks need to be balanced against the benefits. Too often, it has been used for medications which themselves have no proven benefit (such as charcoal), which only compounds the lack of benefit from the NG tube itself. However, I am happy to place an NG tube if it is the only way to administer a potentially life saving medication, such as aspirin administration in an unconscious STEMI patient. (Of course, the harms of NG tubes are also negligible in unconscious patients.)
Can a NG tube help with pancreatitis?
I had never even heard that the NG tube might be helpful in pancreatitis, but apparently that is a widely held belief in some parts of the world. Again, the evidence seems to suggest the exact opposite, with more rapid recovery in patients randomized to no NG tube. (Sarr 1986)
What is the surgical intervention for SBO?
In patients with complete SBO, peritonitis is usually present, which mandates immediate resuscitation and prompt surgical intervention by exploratory laparotomy. Peritonitis will develop in time if not already present; for this reason early surgical intervention is crucial.
What is the purpose of a nasogastric tube?
The placement of a nasogastric tube is indicated to decompress air/fluid in the upper gastrointestinal tract.
What is the treatment for appendicitis?
Specific treatment such as appendectomy for appendicitis, Ladd procedure for malrotation (infants), tumor resection for obstructing tumor, and hernia repair for inguinal hernia should be performed when diagnosed.
How long after surgery can antibiotics be given?
Broad-spectrum antibiotics are indicated preoperatively as prophylaxis for wound infection. Usually antibiotics are administered for up to 24 hours after surgery. In cases of complete SBO, the placement of a nasogastric tube is indicated to decompress air/fluid in the upper gastrointestinal tract.
How long do antibiotics last after surgery?
Usually antibiotics are administered for up to 24 hours after surgery.
What is the purpose of a Foley catheter?
A Foley catheter should be placed to monitor urine output.
How long does it take for exploratory laparotomy to be performed?
An exploratory laparotomy should be performed in patients who do not respond after 48 to 72 hours of nonoperative treatment, as manifest by persistent abdominal pain, leukocytosis, worsening air-fluid levels on abdominal x-ray (or demonstration of a gas-less abdomen), or an inconsolable infant with documented malrotation.
Emergency Department Care
Initial emergency department (ED) treatment of small-bowel obstruction (SBO) consists of aggressive fluid resuscitation, bowel decompression, administration of analgesia and antiemetic as indicated clinically, early surgical consultation, and administration of antibiotics.
Nonoperative inpatient care
Continued NG suction provides symptomatic relief, decreases the need for intraoperative decompression, and benefits all patients. No clinical advantage to using a long tube (nasointestinal) instead of a short tube (NG) has been observed.
Water-soluble oral contrast medium
Studies have evaluated the use of WSCM as a tool in the management of SBO and as a predictive tool for nonoperative resolution of adhesive SBO. Although it does not cause resolution of the SBO, WSCM may reduce the hospital stay in patients not requiring surgery.
Bowel Obstruction Nursing Care Plans Diagnosis and Interventions
Bowel Obstruction (intestinal obstruction) is a condition wherein there is a blockage that prevents food or fluid from entering either the small intestines ( small bowel obstruction ) or the large intestines.
Causes and Risk Factors of Bowel Obstruction
There are two major types of intestinal obstruction and are termed partial blockage or complete blockage. Common causes of bowel obstruction vary for adults and children and may include the following:
Diagnosis of Bowel Obstruction
Diagnosing bowel obstruction will include a combination of tests and procedures and they are:
Bowel Obstruction Nursing Care Plans
Nursing Diagnosis: Acute Pain (Abdominal) related to bowel obstruction as evidenced by reports of cramping abdominal pain and restlessness
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Background
At Clear Passage®, we have always been cautious about keeping patients safe, and making claims about our results. After we opened our first fallopian tubes in 1989, we spent 30 years studying adhesions, refining treatment techniques, having biostatisticians calculate what techniques worked best, further refining, and then publishing our results.
Program and Results
We do not have privileges at your hospital. Our program is designed to clear blockages at our facilities and prevent recurrences. Our most current success rates for preventing recurring bowel obstructions and repeat bowel surgeries is shown below.
Who Can Perform this Therapy?
Manual therapy to the bowel should be undertaken with caution. It should only be performed by therapists who are highly educated and knowledgeable treating the areas that contain the abdominal and reproductive organs.
Elements of Our Bowel Obstruction Program
The years we have spent studying our techniques and results have helped us develop very clear elements for our programs, including
History
Following the ‘scientific method’ for investigating new modalities, we began by publishing some remarkable case studies, all of which can be read at our Published Studies page. These studies included a woman who managed to stay alive despite a bowel that was totally blocked.
Measuring Success
Due to the complex structure and functions of the bowel, me asuring success for patients with recurring small bowel obstruction (SBO) presented opportunities and challenges. We found three major areas of concern that we could measure by comparing conditions before and after therapy: