Gastro and HepatoBilliary Critical Care​

Hepatic Encephalopathy  Hepatic encephalopathy (HE) is a brain dysfunction caused by liver insufficiency and/or portosystemic shunting, producing a spectrum ranging from subtle cognitive impairment to coma. HE is a clinical syndrome, not a diagnosis made by ammonia alone.HE is a diagnosis of exclusion. DEFINITION HE is a syndrome of neurological and psychiatric abnormalities occurring in […]

CONSTIPATION IN ICU  1.  DEFINITION (No universal consensus) Most ICU studies define constipation as: No bowel movement for ≥3 days OR need for rescue laxatives/enema OR hard stools / difficult evacuation 2.  EPIDEMIOLOGY Incidence: 15–83% (very common in ICU) Higher in: Mechanically ventilated patients Sedated/paralyzed patients Opioid use Enteral feeding patients 3.  WHY IT MATTERS

Acute Liver Failure (ALF)  Acute liver failure (ALF) is one of the few true medical emergencies in critical care. It is characterized by rapid loss of hepatic function, resulting in coagulopathy and hepatic encephalopathy in a patient without pre-existing cirrhosis, leading to profound metabolic, hemodynamic, neurologic, immunologic, and multiorgan derangements. For the intensivist, management revolves

 STRESS-RELATED MUCOSAL DISEASE (SRMD) / STRESS ULCERS  I. DEFINITIONS 1. Stress-Related Mucosal Disease (SRMD) Acute erosive and ulcerative gastritis occurring in critically ill patients. Includes: Stress erosions (superficial) Stress ulcers (deep, bleeding lesions) 2. Stress Ulcers Multiple shallow mucosal lesions in the gastric fundus and body, caused by hypoperfusion and acid-mediated injury.  II. PATHOPHYSIOLOGY 1.

Ileus in the ICU  Ileus is a functional, non-mechanical inhibition of intestinal propulsion resulting in impaired transit of gas, fluids, and enteral contents through the gastrointestinal tract without an anatomical obstruction. . Pathophysiology ICU ileus is multifactorial. Cause Mechanism  Neurogenic mechanisms Critical illness causes ↑ sympathetic activity and ↓ parasympathetic (vagal) activity, resulting in reduced

GASTROPARESIS  Delayed gastric emptying in the absence of mechanical gastric outlet obstruction. Epidemiology 40–70% mechanically ventilated patients Up to 60% septic shock patients Common after major surgery More common in: Head injury Stroke Burns Trauma Pancreatitis Multiple organ dysfunction Delayed gastric emptying contributes significantly to Underfeeding Aspiration pneumonia Ventilator-associated pneumonia (VAP) Increased ICU stay Pathophysiology

Acute Pancreatitis Acute Pancreatitis is an acute inflammatory process of the pancreas caused by premature activation of pancreatic digestive enzymes leading to autodigestion, inflammation, edema, necrosis, and systemic inflammatory response. It ranges from: Mild self-limiting interstitial edema to Severe necrotizing pancreatitis with multiorgan failure. Diagnostic Criteria (Revised Atlanta Classification) Diagnosis requires 2 of 3 criteria: