Perioperative management of gastrointestinal disorders

Gastrointestinal disorders present a multitude of problems perioperatively and the severity and extent to which the patient is compromised must be determined. Many disorders of the gastrointestinal tract may present perioperatively with similar general features (e.g. abnormalities of fluid and electrolytes, nutritional failure, respiratory problems) which may need to be optimized. Drug handling is another issue during the perioperative period because the enteral route may not be available; alternative routes of administration and adjustment of doses must be considered. Gastrointestinal disorders may have wide-ranging effects on other organs (e.g. abnormal loss of fluid from vomiting or fistulae may result in electrolyte disturbances that may affect cardiac and renal systems). The patient with severe gastro-oesophageal reflux or intestinal obstruction is at risk of regurgitation or vomiting during induction of anaesthesia with the risk of severe respiratory sequelae.