RT Book, Section
A1 Ehrenpreis, Eli D.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2296099
T1 Chapter 81. Gut and Hepatobiliary Dysfunction
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2296099
RD 2022/05/20
AB Alterations  in  gastrointestinal  motility  occur  commonly  in  critically  ill  patients.The  small  intestine  is  the  site  of  obstruction  in  90%  of  cases  of  mechanical  bowel  obstruction.  Pelvic  adhesions  are  the  most  common  cause.  Thirty  percent  of  cases  require  surgery.Intestinal  pseudo-obstruction  (nonmechanical  bowel  obstruction)  may  present  with  clinical  symptoms  that  are  similar  to  mechanical  obstruction.  Treatment  includes  nasogastric  suction,  rehydration,  and  correction  of  causative  factors.Ogilvie's  syndrome  (colonic  pseudo-obstruction)  is  characterized  by  abdominal  distension  and  marked  dilation  of  the  cecum  and  right  colon  on  abdominal  x-rays.  Treatment  with  colonoscopic  decompression  of  the  right  colon  is  successful  in  about  60%  of  patients.  Intravenous  neostigmine  is  also  effective.The  incidence  of  diarrhea  in  the  critically  ill  is  greater  than  40%  and  is  up  to  60%  in  patients  receiving  enteral  feedings.Clostridium  difficile  infections  are  generally  acquired  in  the  hospital  in  patients  receiving  broad-spectrum  antibiotics.  Measurement  of  C.  difficile  toxin  A  or  B  in  the  stool  by  rapid  enzyme-linked  immunosorbent  assay  (ELISA)  is  the  most  practical  method  for  diagnosis.  Treatment  consists  of  metronidazole  or  vancomycin  for  7  to  14  days.Hyperbilirubinemia  is  frequently  seen  in  patients  with  sepsis;  cytokines  along  with  bacterial  endotoxins  impair  transport  of  bile  acids  at  the  sinusoidal  and  canalicular  membranes,  resulting  in  cholestasis.The  etiology  of  total  parenteral  nutrition  (TPN)-associated  liver  dysfunction  appears  to  be  multifactorial.  The  diagnosis  is  often  made  after  the  exclusion  of  other  causes  such  as  the  concurrent  use  of  potentially  hepatotoxic  medications,  biliary  obstruction,  infections,  and  underlying  intrinsic  liver  disease.Critically  ill  patients  have  multiple  risk  factors  that  predispose  to  acalculous  cholecystitis.  Patients  often  present  atypically;  unexplained  fever  and  evidence  of  occult  infection  may  frequently  be  the  only  manifestations.  Ultrasonography  alone  is  of  limited  value  in  diagnosis.Strong  clinical  suspicion  and  early  recognition  of  acalculous  cholecystitis  are  essential.  Because  of  delays  in  diagnosis,  more  than  40%  of  patients  develop  complicated  disease  with  gangrene,  abscess,  or  perforation  of  the  gallbladder.