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Gastrointestinal dysfunction in the Critically ill Patients
Gastrointestinal dysfunction can be caused by a variety of factors, including stress, infections, food intolerances, medications, and autoimmune disorders. Some gastrointestinal disorders, such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), can be chronic and require ongoing management. Gastrointestinal dysfunction can impact overall health and wellbeing, leading to malnutrition, dehydration, and other complications if left untreated. Treatment for gastrointestinal dysfunction may include dietary changes, medications, and lifestyle modifications, such as exercise and stress reduction. Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics, can disrupt the balance of bacteria in the gut and contribute to gastrointestinal dysfunction.
About the Speaker
Dr. Rishabh Kumar Mittal
M.B.B.S, M.D , F.N.B ( Critical Care Medicine) Principal Consultant , Critical Care Medicine In-charge, Gastro Critical Care & Liver Transplant ICU Max Super speciality Hospital ( Delhi – NCR)
Approach to Infants with GERD-like Symptoms
Begin by obtaining a detailed history, focusing on feeding patterns, regurgitation frequency, and associated symptoms such as irritability and poor weight gain. Conduct a thorough physical examination to identify signs of distress, such as arching of the back, fussiness during or after feeds, and respiratory symptoms. Rule out other causes of similar symptoms, including infections, metabolic disorders, and structural abnormalities. Evaluate the infant's feeding technique, assess for possible overfeeding or intolerance to certain formulas, and consider breastfeeding practices. Implement non-pharmacological interventions, such as feeding position adjustments, smaller and more frequent feeds, and thickening of feeds with rice cereal. If conservative measures prove ineffective, consider acid-suppressing medications under the guidance of a pediatric gastroenterologist, taking into account potential risks and benefits.
Case Discussion on Management of Ulcerative Colitis
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by inflammation and ulceration of the colon and rectum. Ulcerative colitis is one of the two main types of inflammatory bowel diseases, the other being Crohn's disease. Common symptoms include abdominal pain, diarrhea, rectal bleeding, and an urgent need to have a bowel movement. It is a lifelong condition with periods of flare-ups and remission, making long-term management crucial. Unlike Crohn's disease, UC primarily affects the colon and rectum, often starting in the rectum and spreading upwards. The severity of UC can vary, ranging from mild with occasional symptoms to severe and debilitating. The exact cause of UC is unknown, but it's believed to result from a combination of genetic, environmental, and immune system factors. Diagnosis involves a combination of medical history, physical examination, colonoscopy, and imaging studies to visualize the colon. Treatment aims to reduce inflammation and manage symptoms. Medications, dietary changes, and in severe cases, surgery may be necessary.
Gastroesophageal Reflux Disease: Case Discussion
Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when stomach acid flows back into the esophagus, causing heartburn and other symptoms. GERD can cause damage to the esophagus, pharynx, or respiratory tract if left untreated. Symptoms of GERD include heartburn, regurgitation of sour or bitter liquid, difficulty swallowing, and chest pain. A diagnosis of GERD starts with a physical examination and a description of symptoms and medical history. Treatment for GERD includes lifestyle changes such as losing weight, avoiding alcohol and tobacco, and avoiding large meals before bedtime. Medications such as antacids, H2 blockers, and proton pump inhibitors can also help relieve symptoms. In severe cases, surgery may be necessary.