Gastrointestinal system

The response of the gastrointestinal tract to shock includes decreased peristalsis with gastric dilatation, stress ulceration, and hypoperfusion of the mucosa leading to altered barrier function. A plain abdominal radiograph may indicate ileus or perforation. A left lateral decubitus radiograph may reveal free air more readily. An ultrasound examination or CT scan of the abdomen may show evidence of pancreatitis, ascites, and fluid collections. Intra-abdominal free fluid or collections and fluid from intra-abdominal drains should be sent for culture and biochemistry. If there is suspicion of gastrointestinal bleeding or infection, an esophagogastroduodenoscopy should be performed.

There is increasing interest in direct and indirect assessment of splanchnic perfusion. The mucosa of the gastrointestinal tract may be particularly sensitive to hypoperfusion, and is accessible to monitoring via oral or rectal routes. Gastric tonometry has recently been proposed as a simple non-invasive method of estimating mucosal acidosis (pH^^^g or pH), giving an estimate of the relative state of perfusion of the mucosa. Assessment of pH i may be of prognostic significance and may be useful in monitoring the gastrointestinal tract in the multisystem involvement following shock. However, its relevance to continued clinical management is as yet unclear.

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