Description
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.
Résumé
- Critical illness significantly impacts the gastrointestinal (GI) system, often overlooked in favor of vital organ support. This can lead to various GI complications that, while not always directly fatal, contribute to poorer patient outcomes and increased mortality. These complications stem from compromised mucosal blood supply, pressure effects, altered motility, and changes in splanchnic circulation.
- Stress-related mucosal disease, or stress ulcers, is common in ICU patients. While often occult, severe cases can lead to significant bleeding and increased mortality, though this is more indicative of overall patient severity. Prophylaxis with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists is recommended for high-risk patients like those on ventilators or with coagulopathies, but indiscriminate use carries risks like pneumonia and C. difficile infection.
- Motility disorders such as gastroesophageal reflux disease (GERD) and gastroparesis are prevalent in critically ill individuals. GERD is exacerbated by recumbent positioning, nasogastric tubes, and certain medications. Gastroparesis, delayed gastric emptying, presents with nausea, vomiting, and abdominal distension. Treatment involves correcting reversible causes, small-volume feeds, and motility-enhancing drugs like metoclopramide and erythromycin.
- Ileus, a disruption in coordinated intestinal motility, leads to stasis and symptoms similar to gastroparesis. Differentiating it from mechanical obstruction is crucial, relying on bowel sounds and radiological findings. Management involves electrolyte correction, early enteral nutrition, and addressing underlying conditions, with nasogastric tube insertion generally discouraged.
- Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by cecal dilation without mechanical obstruction, posing a risk of perforation. Neostigmine is used to treat it and can be combined with glycopyrrolate, with colonoscopic decompression or surgery considered if medical management fails.
- Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) arise from increased abdominal pressure, impairing organ function. Management ranges from medical therapies like sedation and diuresis to surgical decompression, depending on the cause and severity. Measuring intra-abdominal pressure through transbladder pressure is essential for diagnosis and management.
- Acute mesenteric ischemia, stemming from compromised splanchnic circulation, is another serious complication. Diagnosis involves laboratory tests (lactate, WBC count) and imaging (CT angiography). Management includes fluid resuscitation, antibiotics, and potentially surgical intervention.
- Diarrhea is a frequent non-hemorrhagic GI complication, often overlooked. Causes are diverse, including medications, enteral feeds, and C. difficile infection. Effective management involves accurate diagnosis, addressing underlying causes, and appropriate antibiotic stewardship. Newer scoring systems, like the gastroenteritis function score, are used to help manage.
Exemple de certificat
À propos des intervenants
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)
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