Gastrointestinal problems in intensive care

Gastrointestinal issues are common in ICU and include both surgical and non-surgical problems. A high index of suspicion and regular clinical assessment are necessary due to inherent difficulties evaluating critically ill and ventilated patients. Gastrointestinal failure may complicate or even precipitate multi-organ failure with systemic inflammatory response due to bacterial translocation. Intra-abdominal hypertension can be under-recognized and causes renal failure and other complications. Although colonic pseudo-obstruction is often conservatively managed, early recognition and treatment can prevent perforation. Stress-related mucosal bleeding is common in ICU, but serious gastrointestinal haemorrhage is rare. Early enteral nutrition and H2-receptor antagonists reduce the incidence of upper gastrointestinal bleeding in high-risk ICU patients. Although delayed bowel motions are the norm, lack of defecation may also occur. This does not necessarily equate to constipation and should only be treated if problems occur.