Decode Medicine from Ward Rounds to ICU rounds
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 […]
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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
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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.
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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:
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Upper Gastrointestinal Bleeding (UGIB) Definition Upper GI bleeding refers to hemorrhage originating proximal to the ligament of Treitz (esophagus, stomach, duodenum). Anatomical Classification Site Examples Esophagus Varices, Mallory–Weiss tear, esophagitis Stomach Peptic ulcer, erosive gastritis, malignancy Duodenum Peptic ulcer, Dieulafoy lesion Etiology 1. Non-Variceal UGIB (≈ 80–85%) Peptic Ulcer Disease (most common) Duodenal ulcer >
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Refeeding Syndrome Refeeding syndrome is a potentially fatal metabolic complication that occurs after rapid reintroduction of nutrition (especially carbohydrates) in malnourished or starved patients, characterized by acute shifts of phosphate, potassium, magnesium, fluids, and vitamins (notably thiamine) due to insulin surge. Core hallmark: Hypophosphatemia after refeeding. diagnosis of exclusion Pathophysiology 1️⃣ Starvation State ↓ Insulin,
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Ascites Normal peritoneal cavity contains <50 mL fluid which is usually not visible on routine abdominal ultrasound. Clinically detectable ascites usually requires >1.5 L fluid. Most common cause worldwide: Liver cirrhosis (~80–85% cases). Epidemiology Among patients with cirrhosis: Ascites is the most common complication. Approximately 50% develop ascites within 10 years of diagnosis. Development of
Hepatorenal Syndrome (HRS) Definition Hepatorenal syndrome (HRS) is a functional, potentially reversible acute kidney injury (AKI) occurring in patients with advanced cirrhosis and portal hypertension(Ascites), in the absence of intrinsic renal disease or structural kidney damage. Epidemiology Occurs in advanced decompensated cirrhosis (often Child-Pugh C) Triggers: Refractory ascites Spontaneous bacterial peritonitis (SBP) Large-volume paracentesis without
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