Gastro Intestinal
The Gastrointestinal (GI) system plays a crucial role in digestion, nutrient absorption, and the elimination of waste from the body.
Acute Pancreatitis
Acute pancreatitis is a sudden inflammation of the pancreas, a vital organ responsible for producing digestive enzymes and insulin. The condition occurs when digestive enzymes become activated while still inside the pancreas, leading to autodigestion and inflammation of pancreatic tissue. This inflammatory process can range from mild and self-limiting to severe and life-threatening. The most common causes include gallstones, which block the pancreatic duct, and excessive alcohol consumption. Other potential causes include high triglyceride levels, certain medications, infections, and post-endoscopic retrograde cholangiopancreatography (ERCP) complications.
Patients typically present with severe, constant epigastric or upper abdominal pain that often radiates to the back, along with nausea, vomiting, abdominal distension, and fever. In severe cases, systemic signs like hypotension, respiratory distress, and altered mental status may occur, reflecting multi-organ involvement. Laboratory findings commonly reveal elevated serum amylase and lipase, along with abnormalities in liver function tests, electrolytes, and inflammatory markers.
Abdominal Compartment Syndrome
Abdominal compartment syndrome (ACS) is a critical condition that results from increased intra-abdominal pressure (IAP), leading to impaired organ perfusion and dysfunction across multiple systems. It often develops in critically ill or postoperative patients due to conditions such as severe pancreatitis, massive fluid resuscitation, abdominal trauma, hemorrhage, or bowel obstruction. As the pressure within the abdominal cavity rises, blood flow to vital organs like the kidneys, liver, intestines, and lungs is compromised, resulting in ischemia and potential organ failure.
Clinically, ACS may present with a tense, distended abdomen, decreased urine output, hypotension, respiratory compromise, and rising ventilatory pressures in intubated patients. Measurement of intra-abdominal pressure using a bladder catheter is essential for diagnosis, with pressures above 20 mmHg accompanied by new organ dysfunction confirming the syndrome.
Management involves prompt recognition and decompression of the abdominal cavity to relieve pressure. This may be done surgically through a decompressive laparotomy or, in some cases, percutaneously. Supportive care includes optimizing fluid balance, reducing abdominal wall tension, and managing any underlying causes like infection or hemorrhage. If not treated urgently, ACS can rapidly progress to irreversible organ failure and death.
Acute Liver Failure
Acute liver failure (ALF) is a rare but devastating condition characterized by the sudden loss of liver function in a previously healthy individual, typically within days or weeks. It is defined by the rapid onset of coagulopathy (INR >1.5) and hepatic encephalopathy in the absence of preexisting liver disease. The most common causes include viral hepatitis (especially hepatitis A, B, and E), drug-induced liver injury (particularly acetaminophen overdose), autoimmune hepatitis, and ischemic hepatitis. In some cases, the cause may remain idiopathic.
The clinical picture of ALF can evolve rapidly. Early symptoms such as fatigue, nausea, abdominal pain, and jaundice may quickly progress to confusion, disorientation, and coma due to hepatic encephalopathy. Laboratory tests typically reveal elevated liver enzymes, hyperbilirubinemia, prolonged clotting times, and low albumin. Cerebral edema, renal failure, metabolic acidosis, and systemic infections are common and contribute significantly to mortality.
Management of ALF is complex and best conducted in an intensive care or transplant center. Key priorities include supportive care, monitoring for cerebral edema, managing coagulopathy, treating infections, and addressing the underlying cause if identified. In many cases, urgent liver transplantation is the only life-saving intervention. The prognosis depends heavily on the etiology, the speed of diagnosis and treatment, and the availability of transplantation facilities.
Infections
Infections in the gastrointestinal tract and critically ill patients are a major cause of morbidity and mortality. They can be localized, such as infectious gastroenteritis, cholangitis, or peritonitis, or systemic, like sepsis secondary to GI perforation or intra-abdominal abscesses. Common pathogens include bacteria such as E. coli, Klebsiella, Salmonella, Clostridioides difficile, and Enterococcus, as well as viruses and fungi in immunocompromised patients.
Spontaneous bacterial peritonitis (SBP) is a serious infection occurring in patients with cirrhosis and ascites, often caused by gram-negative organisms. Clostridioides difficile infection is another major healthcare-associated illness, leading to severe colitis and toxic megacolon, especially in patients on broad-spectrum antibiotics. Infections in necrotizing pancreatitis, infected pseudocysts, and liver abscesses are also significant and require prompt drainage and antimicrobial therapy.
Management of infections involves targeted antibiotic therapy, source control through drainage or surgery, and supportive measures like fluid resuscitation and vasopressors in septic shock. Early recognition, appropriate empirical therapy, and antimicrobial stewardship are essential to improve outcomes and prevent complications such as sepsis, multi-organ dysfunction, and death.