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Critical Care Focus 9: The Gut - part 2

Quản lý y tế không variceal trên đường tiêu hóa xuất huyết Paul Winwood xuất huyết cấp tính đường tiêu hóa trên là một lý do tương đối phổ biến cho nhập viện và cho đến gần đây đã có chút thay đổi trong tỷ lệ tử vong trong vòng năm mươi năm qua. Chảy máu cấp tính cũng xảy ra ở những bệnh nhân đã ở trong bệnh viện | INTRODUCTION Medical management of non-variceal upper gastrointestinal haemorrhage Paul Winwood Acute upper gastrointestinal haemorrhage is a relatively common reason for admission to hospital and until recently there has been little change in mortality over the last fifty years. Acute bleeding also occurs in patients already in hospital and contributes significantly to overall mortality. Critically ill patients in particular are at increased risk of developing bleeding in the upper gastrointestinal tract usually as a result of peptic ulceration. Most patients with acute haemorrhage are managed conservatively or with endoscopic intervention but some ultimately require surgery to arrest the haemorrhage. Endoscopic therapy has become a mainstay of the managing of upper gastrointestinal haemorrhage and this is the area where there has been perhaps the most advances in the last decade. This article describes the incidence and risk of re-bleeding and mortality in patients with bleeding ulcers and describes available therapeutic options. Acute pancreatitis John R Clark Jane Eddleston Acute pancreatitis is a common disease on the intensive care unit which is ruled by its complications despite considerable increases in knowledge as a result of animal studies concerning the seminal events within the pancreatic acinar cell at the evolution of the acute inflammation. This article describes the epidemiology aetiology and controversial clinical issues including feeding new therapies and thoughts on future therapeutic options. xi 1 Gut dysfunction during enteral feeding ANNA M BATCHELOR Introduction It is generally accepted that enteral feeding is preferable to parenteral feeding for critically ill patients since it reduces mortality it decreases the number of complications and of course it is much cheaper than parenteral nutrition Box 1.1 . However achieving targets for feeding remains problematic since delayed gastric emptying common in such patients can be a cause of feeding