Gastrointestinal problems in intensive care

Gastrointestinal problems are common in intensive care units (ICUs) and include both surgical and non-surgical causes. A thorough clinical examination and high index of suspicion are necessary due to difficulty eliciting symptoms from ventilated and critically ill patients. Gastrointestinal failure may complicate or precipitate multi-organ failure with systemic inflammation due to bacterial translocation. Intra-abdominal hypertension and abdominal compartment syndrome are under-recognized and can cause renal failure. Colonic pseudo-obstruction needs to be recognized early, as treatment can prevent perforation.Stress-related mucosal bleeding is common in ICUs, but serious gastrointestinal haemorrhage is rare, with enteral nutrition and H2-receptor antagonists reducing the incidence in high-risk patients. Although delayed bowel motions are the norm, constipation is unusual and should only be treated if it becomes problematic.