Radiographic and Other Studies

1. Chest x-ray and abdominal obstruction series. Look for free intraperitoneal air or obstruction. Mediastinal air suggests esophageal perforation. Upright chest x-ray may show a large stomach bubble, indicating poor gastric emptying. Check position of the tube. Upright and flat abdominal x-rays may show distended bowel, indicating ileus or obstruction.

2. Contrast swallow study. To identify gastric outlet obstruction or partial small bowel obstruction, order a Gastrografin or dilute barium swallow study. Contrast should not be used in patients with ileus or complete obstruction.

V. Plan. First, determine stability of patient and whether bleeding, if present, is serious enough to require aggressive therapy. Determine if NG tube is functioning properly and is in correct position. Note: Do not reposition an NG tube without a full understanding of why the tube was placed and, if applicable, details of surgery performed.

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