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Gastro Critical Care

Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. 

Overview - Gastro Critical Care

The problems in defining GI dysfunction or gastro ciritical care start with defining GI function. Next to the digestive tract, the GI tract also carries out endocrine, immune and barrier functions. The clinical assessment of the impairment of these functions today is more intuitive than objective.

We will learn about some of the common gastro critical diseases and their treatments.

Acute Liver Failure

Defined as jaundice, encephalopathy, coagulopathy. 

Causes are:
  • Sepsis
  • Idiosyncratic Drug Reaction
  • Paracetamol Poisoning
  • Viral Hepatitis
Treatments include:
  • N-Acetyl Cysteine
  • Steroids
  • In severe cases requires intubation mechanical ventilation
  • Emergency Liver
  • Transplant

Acute Necrotising Pancreatitis

Necrotising pancreatitis (NP) is a health problem in which part of your pancreas dies. This is because of inflammation or injury.

Causes are:
  • Alcoholism
  • Gall Bladder Stones
  • Idiopathic chronic pancreatitis

Acute Pancreatitis

Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides.

Requires
  • Fluid Resuscitation
  • ERCP For Priliary Pancreatitis Involving CBD Stone
  • Conservative Treatment
  • In Acute Severe Necratising Pancreatitis

Patient had multiorgan failure can develop: ARDS, AKI

(WOPN) – Infected Walled of Peripancreatic Neurosis
  • In severe sepsis cases requires minimally invasive percutaneous drainage
  • According to step up approach in cases of acute severe necratising pancreatitis requires
    • Video Assisted Retroperitoneal Debridement (VARD) or open necrosectomy after 45 days of disease

Chronic Liver Disease (CLD)

Chronic liver disease occurs when the scar tissue replaces healthy tissue in the body’s liver. Chronic liver disease occurs through various health conditions. The most common conditions often stem from alcohol abuse.

Common causes of admission in Chronic Liver Failure
    • Sepsis
    • Ascitis
    • Peritonitis
    • HRS
    • GL bleeding
    • Hepatic Encephalopathy
    • Acute on chronic liver failure

Chronic liver failure patients are relative immuno compromised stat.
High tendency to develop sepsis & septic shock.

Ascites

Ascites is the buildup of fluid in your belly, often due to severe liver disease. The extra fluid makes your belly swell. 

Common causes include:
    • progression of the liver disease
    • Non-compliance of the treatment
    • Development of sepsis in abdominal fluid.
Treatments include:
    • Diuretics
    • Albumin Injection
    • Ascitic Fluid Tapping
    • Treatment of sepsis

Spontaneous bacterial peritonitis (SBP)

Spontaneous bacterial peritonitis (SBP) is the infection of ascitic fluid in the absence of any intra‐abdominal, surgically treatable source of infection.

    • Spontaneous Bacterial Peritonitis (SBP)
    • Infection of peritoneal fluid
    • Common in patient with CLD
    • Have to manage aggressively with antibiotics and albumin to avoid hepato renal syndrome.

Gastro Intestinal Bleeding

GI bleeding is not a disease, but a symptom of a disease. The blood often appears in stool or vomit but isn’t always visible, though it may cause the stool to look black or tarry. The level of bleeding can range from mild to severe and can be life-threatening.

Types:
    • Upper GI Bleeding
    • Lower GI Bleeding
Upper GI Bleeding – Common Causes
    • Esophageal and stomach varices
    • Gastric ulcers
    • Esophageal ulcer
Upper GI Bleeding – Treatment
    • Resuscitation and management of hemorragic and hypovolemic shock
    • Inj. pantoprazole infusion
    • For varical bleeding – Somatostatin, Terlypressin Injection
    • Urgent endoscopy and hemostasis achievement
Lower GI Bleeding – Causes
    • Diverticulum
    • Piles
    • Ulcer Bleed
Lower GI Bleeding – Requires
    • Colonoscopy to diagnose
    • May require colonoscopic intervention
    • In severe cases surgical intervention

Hepatic Encephalopathy

Hepatic encephalopathy is a nervous system disorder brought on by severe liver disease. When the liver doesn’t work properly, toxins build up in the blood.

Common Causes:
    • Sepsis
    • Upper GI Bleeding
    • Liver Failure
Treatment
    • Treatment of precipitating cause
    • Antibiotic
    • Rifaximine
    • Lactalose

FAQs & Info

Mesenteric vascular is major surgical emergency, requires immediate anticoagulation, urgent surgical intervention.

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    Causes are:
    • Sepsis
    • Idiosyncratic Drug Reaction
    • Paracetamol Poisoning
    • Viral Hepatitis

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