Decreased output

a. Correlate this return with physical exam and passage of flatus and stool. The latter usually indicates return of bowel function.

b. Remove NG tube, if appropriate.

c. Irrigate tube to clear it, or advance tube into the stomach if it is not positioned correctly.

VI. Problem Case Diagnosis. The 3-year-old boy who had bloody NG tube drainage after surgery for intussusception underwent gastric lavage, which revealed fresh blood and "coffee ground" residue. Hemoglobin remained stable. Stool was not grossly bloody and was negative for occult blood. ENT exam revealed a posterior nosebleed, arising from the nostril containing the NG tube.

VII. Teaching Pearl: Question. What type of intestinal obstruction usually cannot be relieved with NG suction?

VIII. Teaching Pearl: Answer. Patients with colonic obstruction and a competent ileocecal valve, or patients with a closed (or "blind") bowel loop obstruction are poorly decompressed by NG suction. If a patient on NG suction develops increased abdominal pain and distention along with worsening of bowel dilation on abdominal obstruction series, surgical intervention may be necessary.

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