Page 200 - Critical Care Notes

4223_Tab06_175-198 29/08/14 8:27 AM Page 194

GI

Diagnostic Tests
■ Abdominal x-ray, CT scan, and ultrasound of the abdomen
■ Contrast enema or small bowel series
■ Colonoscopy and laparoscopy
■ CBC and serum chemistries
Management
■ Insert NG tube and connect to low intermittent suction; assess color and
amount of drainage.
■ Administer IV fluids, and assess fluid and electrolyte balance.
■ Monitor nutritional status. Monitor intake and output.
■ Assess abdomen for bowel sounds, pain, and distention.
■ Administer analgesics for pain.
■ Prepare patient for surgery as indicated to relieve the obstruction. Acute
complete SBO is a surgical emergency.
Bowel Infarction or Acute Mesenteric Ischemia
Pathophysiology
Decreased blood supply to bowel and mesenteric circulation → ischemia →
gangrene of bowel wall → bowel infarction.
Clinical Presentation
■ Severe acute abdominal pain
■ Bloody stools with diarrhea
■ Fever
■ Nausea and vomiting, abdominal distention with guarding and tenderness
Diagnostic Tests

■ CBC with elevated WBC
■ Barium enema, colonoscopy
■ Abdominal x-ray, CT of abdomen, ultrasound of abdomen

194