Small-Bowel Obstruction Medication
- Author: Brian A Nobie, MD, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM more...
Medication Summary
Fluid replacement with aggressive intravenous (IV) resuscitation using isotonic saline or lactated Ringer solution is indicated. Oxygen and appropriate monitoring are also required. Antibiotics are used to cover gram-negative and anaerobic organisms. In addition, analgesia and antiemetic are administered as indicated clinically. As previously mentioned, a nonoperative trial of as many as 3 days is warranted for partial or simple obstruction. Resolution of obstruction occurs in virtually all patients with these lesions within 72 hours.
Antibiotics
Class Summary
These agents are for prophylaxis in surgical intervention, if needed.
Cefazolin
Cefazolin is a first-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth.
Cefoxitin (Mefoxin)
Cefoxitin is a second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.
Cefotetan
Cefotetan is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Dosage and route of administration depend on the condition of patient, the severity of infection, and the susceptibility of the causative organism.
Cefuroxime (Ceftin, Zinacef)
Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, E coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of the patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.
Meropenem (Merrem)
Meropenem is a bactericidal, broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. It is effective against most gram-positive and gram-negative bacteria.
Antiemetic
Class Summary
These agents should be administered for symptomatic relief, usually in conjunction with GI decompression via placement of an NG tube for suction.
Promethazine (Phenergan, Phenadoz, Promethegan)
Promethazine is for the symptomatic treatment of nausea and vomiting. It is an antidopaminergic agent that is effective in treating emesis. Promethazine blocks postsynaptic mesolimbic dopaminergic receptors in the brain and reduces stimuli to the brainstem reticular system.
Ondansetron (Zofran, Zuplenz)
Ondansetron is a selective 5-HT3-receptor antagonist that blocks serotonin peripherally and centrally; it is used in the prevention of nausea and vomiting. Ondansetron is metabolized in the liver through the P-450 pathway.
Analgesics
Class Summary
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.
Morphine sulfate (Astramorph, MS Contin, Kadian, Oramorph)
This is the drug of choice for analgesia due to its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various IV doses are used; morphine sulfate is commonly titrated until the desired effect is obtained.
van der Wal JB, Iordens GI, Vrijland WW, van Veen RN, Lange J, Jeekel J. Adhesion prevention during laparotomy: long-term follow-up of a randomized clinical trial. Ann Surg. Jun 2011;253(6):1118-21. [Medline].
Thompson WM, Kilani RK, Smith BB, Thomas J, Jaffe TA, Delong DM, et al. Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter?. AJR Am J Roentgenol. Mar 2007;188(3):W233-8. [Medline].
Lappas JC, Reyes BL, Maglinte DD. Abdominal radiography findings in small-bowel obstruction: relevance to triage for additional diagnostic imaging. AJR Am J Roentgenol. Jan 2001;176(1):167-74. [Medline].
Sheedy SP, Earnest F 4th, Fletcher JG, Fidler JL, Hoskin TL. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology. Dec 2006;241(3):729-36. [Medline].
Diaz JJ Jr, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for management of small bowel obstruction. J Trauma. Jun 2008;64(6):1651-64. [Medline].
Kim JH, Ha HK, Sohn MJ, Shin BS, Lee YS, Chung SY, et al. Usefulness of MR imaging for diseases of the small intestine: comparison with CT. Korean J Radiol. Jan-Mar 2000;1(1):43-50. [Medline]. [Full Text].
Beall DP, Fortman BJ, Lawler BC, Regan F. Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol. Aug 2002;57(8):719-24. [Medline].
Regan F, Beall DP, Bohlman ME, Khazan R, Sufi A, Schaefer DC. Fast MR imaging and the detection of small-bowel obstruction. AJR Am J Roentgenol. Jun 1998;170(6):1465-9. [Medline].
Raptopoulos V, Schwartz RK, McNicholas MM, Movson J, Pearlman J, Joffe N. Multiplanar helical CT enterography in patients with Crohn's disease. AJR Am J Roentgenol. Dec 1997;169(6):1545-50. [Medline].
Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fidler JL, Barlow JM, et al. Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography--correlation with endoscopic and histologic findings of inflammation. Radiology. Feb 2006;238(2):505-16. [Medline].
Engin G. Computed tomography enteroclysis in the diagnosis of intestinal diseases. J Comput Assist Tomogr. Jan-Feb 2008;32(1):9-16. [Medline].
Rajesh A, Maglinte DD. Multislice CT enteroclysis: technique and clinical applications. Clin Radiol. Jan 2006;61(1):31-9. [Medline].
Gollub MJ. Multidetector computed tomography enteroclysis of patients with small bowel obstruction: a volume-rendered "surgical perspective". J Comput Assist Tomogr. May-Jun 2005;29(3):401-7. [Medline].
Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. May 2008;92(3):575-97, viii. [Medline].
Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. Aug 2011;28(8):676-8. [Medline].
Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann Surg. Apr 2000;231(4):529-37. [Medline]. [Full Text].
Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. The laparoscopic management of small-bowel obstruction. Am J Surg. Dec 2007;194(6):882-7; discussion 887-8. [Medline].
Khaikin M, Schneidereit N, Cera S, Sands D, Efron J, Weiss EG, et al. Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients' outcome and cost-effectiveness. Surg Endosc. May 2007;21(5):742-6. [Medline].
Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. Feb 17 2010;CD007511. [Medline].
Print
