Gastrointestinal Disorders and Hepatic Disturbance

Gastrointestinal and hepatic disturbance

The intestinal mucosa is vulnerable in shock, and ischaemia and

ulceration commonly occur. With loss of the mucosal barrier, toxins

can enter the portal circulation.

Hepatic dysfunction in critical illness can take three forms:

● ‘Shock liver’ with necrosis, hypoglycaemia, deranged LFTs

and lactic acidosis.

 ● Hyperbilirubinaemia due to cholestasis.

● Transaminitis, commonly due to drug toxicity.

Early institution of enteral nutrition is the most effective strategy

for protecting the gut mucosa and providing nutrition. Total

parenteral nutrition (TPN) should be started if attempts at enteral

feeding have failed. Close glycaemic control (using insulin when

needed) and stress ulcer prophylaxis improve outcomes.

Symptoms of gastrointestinal infections include:

• diarrhea
• nausea
• vomiting
• stomach cramps
• loss of appetite
• a fever
• muscle aches
• an electrolyte imbalance
• gas and bloating
• unintentional weight loss

 

When should we consult a Doctor?

serious torment in the midsection

 a high fever

 looseness of the bowels that endures longer than 2 days

 dark or delay stools

 at least six diarrheas each day

 continuous spewing

 changes in mental state

 

Grown-ups ought to likewise see a specialist for a gastrointestinal disease on the off chance that they can't hold down fluid or give indications of drying out, including:

 outrageous thirst

 dim, rare pee

 indented cheeks and eyes

 a dry mouth

 skin that doesn't straighten back in the wake of squeezing

 unsteadiness

Neurological problems in intensive care

Impaired consciousness or coma is often an early feature of severe

systemic illness. Prompt assessment and management of airway,

breathing and circulation are essential to prevent further brain

injury, to allow diagnosis and to permit definitive treatment to

be instituted. Impaired conscious level is graded according to

the Glasgow Coma Scale, which is also used to monitor progress. A

targeted neurological examination is very important in the unconscious

patient, noting:

● Pupil size and reaction to light.

 ● Presence or absence of neck Stiffness

Focal neurological signs.

● Evidence of other organ impairment

Management

The aim of management in acute brain injury is to optimise cerebral

oxygen delivery by maintaining a normal arterial oxygen content

and a cerebral perfusion pressure > 60 mmHg. A rise in intracranial

pressure (ICP) as a result of haematoma, contusions or ischaemic

swelling is damaging both directly to the cerebral cortex and by

producing downward pressure on the brain stem, and indirectly by

reducing cerebral perfusion pressure. ICP can be reduced by ventilation

to lower PaCO2 to 4–4.5 kPa (~30–34 mmHg), by the osmotic

diuretic mannitol and by craniotomy. Head-up tilt and control of

epileptic seizures are also important.

Neurological monitoring must be combined with frequent

clinical assessment. The motor response to pain is a particularly

important prognostic sign. No response or extension of the upper limbs is associated with severe injury, and unless there is

improvement within a few days, prognosis is very poor. A flexor

response is encouraging and indicates that a good outcome is still

possible.

Critical illness polyneuropathy is another potential complication

in patients with sepsis and multiple organ failure. It can result in

areflexia, gross muscle-wasting and failure to wean from the ventilator,

thus prolonging the duration of intensive care.