What are the medical orders for managing Small Bowel Obstruction (SBO) in an inpatient?

From the Guidelines

Medical management of a small bowel obstruction (SBO) in the inpatient setting should begin with bowel rest, nasogastric tube decompression, IV fluid resuscitation, and electrolyte correction, as recommended by the most recent guidelines 1.

Initial Management

The initial management of SBO should include:

• Insertion of a nasogastric tube connected to low intermittent suction to decompress the bowel and prevent aspiration pneumonia, as suggested by 1
• Maintenance of NPO (nil per os) status to rest the bowel
• Administration of IV fluids, such as lactated Ringer's or normal saline, at a rate of 125-150 mL/hr, adjusting based on patient status, to ensure adequate hydration and electrolyte balance
• Monitoring of electrolytes every 6-12 hours and correction of imbalances as needed, as recommended by 1

Pain and Nausea Management

Adequate pain control and nausea management are crucial in the treatment of SBO:

• Pain control can be achieved with medications like morphine 2-4 mg IV every 4 hours or hydromorphone 0.5-1 mg IV every 4 hours
• Antiemetics, such as ondansetron 4 mg IV every 8 hours or prochlorperazine 5-10 mg IV every 6 hours, can help manage nausea

Serial Assessments and Imaging

Regular assessments and imaging studies are essential to monitor the patient's progress and detect any potential complications:

• Serial abdominal exams should be performed every 4-6 hours to assess for peritoneal signs
• Abdominal X-rays can be obtained every 12-24 hours to track obstruction progression

Surgical Consultation

Surgical consultation is warranted if the patient shows no improvement after 48-72 hours of conservative management or develops signs of bowel ischemia, as recommended by 1 and 1. The approach outlined above allows for bowel decompression and rest, which often resolves partial obstructions, while maintaining adequate hydration and symptom control during the recovery period.

From the Research

Medical Orders for Managing Small Bowel Obstruction (SBO)

The medical orders for managing SBO in an inpatient setting include:

• Intravenous fluid resuscitation to prevent dehydration and electrolyte imbalances 2
• Analgesia to manage pain and discomfort 2
• Nasogastric tube decompression to remove contents proximal to the site of obstruction and relieve vomiting 2, 3
• Bowel rest to reduce bowel movements and alleviate symptoms 3, 4
• Abdominal examinations every 4 hours to monitor for signs of complications such as strangulation or perforation 3
• Laboratory values and imaging studies such as computed tomography (CT) scans to diagnose and monitor the obstruction 2, 3
• Surgical consultation and admission for patients with complete or complicated obstructions, or those who fail nonoperative therapy 2, 3

Diagnostic and Therapeutic Interventions

Diagnostic and therapeutic interventions for SBO include:

• Administration of Gastroview (GV) via nasogastric tube to diagnose and treat partial adhesive small bowel obstruction (aSBO) 3
• Plain abdominal films to monitor the progression of the obstruction and the effectiveness of treatment 3
• CT scans with intravenous contrast to evaluate the extent of the obstruction and detect any complications such as bowel ischemia or perforation 2, 3

Controversies and Variations in Management

There are controversies and variations in the management of SBO, including:

• The use of nasogastric decompression in patients without active emesis, with some studies suggesting that it may not be necessary and may even increase the risk of complications such as pneumonia and respiratory failure 4
• The timing and approach to surgical intervention, with some studies suggesting that a less invasive approach may be effective in certain cases 5, 6