The gastrointestinal tract, although rarely the center of attention in the intensive care unit (ICU), will either facilitate or impede the return to good health of every critically ill patient. Aside from its primary function of digestion and absorption of nutrients, a healthy gut plays a central role in maintaining metabolic homeostasis, meeting the body's caloric needs, assuring fluid balance, providing a physiological and bacteriological barrier to infection, and supporting immunocompetence. The bacteriological load of the gut is formidable, and the integrity of the gut membrane barrier is essential to continued survival. Yet the absence of measurable indicators of gut dysfunction in critical illness makes intestinal health a low priority when more visible needs are being addressed. Indeed, it typically takes a crisis, be it hemorrhage, diarrhea, or perforation, to alert the intensivist to the absolute requirement for reasonable gut health to be achieved and maintained.

The first presentation of a gastrointestinal problem is often the radiographic demonstration of fluid-filled loops of bowel with or without abdominal distension. Immediate concerns of ileus or obstruction are raised. Rapid differentiation between these two entities is important although difficult, as they present with similar clinical pictures but signify vastly different pathologies ( Fromm 1993). Because mechanical bowel obstruction, albeit rare in the ICU patient, portends disaster if missed or acted upon late, a systematic approach to care is required.

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