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
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:
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.
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