Five to fifteen percent of patients in intensive care units (ICUs) experience acute deterioration in renal function. , Renal dysfunction substantially adds to the morbidity and mortality of critically ill patients. Moreover, changes in renal function directly affect drug clearance.…
Introduction The kidney plays a key role in maintaining solute, water, and acid-base homeostasis. Some or all of these roles may be impaired in critically ill patients because of processes that disrupt glomerular, tubular, or interstitial function. This chapter will…
Gastrointestinal bleeding is common, and severe bleeding often requires intensive care unit admission. Optimal management requires hemostatic resuscitation, management of antiplatelet and anticoagulant agents, acid suppression, and a multidisciplinary approach to localization for hemorrhage control, summarized in Fig. 93.1 .…
Acute megacolon refers to a syndrome defined by abnormal colonic distention in the absence of mechanical obstruction. Megacolon may be a manifestation of Ogilvie’s syndrome or toxic megacolon. The sequelae of these disorders results in diffuse colonic dysmotility. Ogilvie’s syndrome…
Mechanical bowel obstruction occurs when there is an occlusion of the lumen of the intestine that causes a blockage of the normal flow of intraluminal contents through the gastrointestinal tract. As a common surgical emergency, 3.2 million cases of bowel…
Introduction Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and accounts for approximately 20% of deaths worldwide. Despite tremendous advancements in early diagnosis and both surgical and antimicrobial therapies, it remains a leading…
Acute pancreatitis is an inflammatory condition of the exocrine pancreas, the severity of which can range from mild edematous changes to severe acute necrotizing pancreatitis. Pancreatitis is one of the most common diseases requiring inpatient hospitalization with an incidence of…
Evaluating the patient with a possible acute abdomen and intraabdominal sepsis in the intensive care unit (ICU) can be challenging. Patients frequently have multiple potential sources of sepsis and are often unable to describe symptoms or localize tenderness on physical…
Introduction Acute liver failure (ALF), also known as fulminant hepatic failure, is a compelling example of complex critical illness. The initiating event is extreme liver injury from a variety of possible causes. Thereafter, a severe multisystem critical illness rapidly develops,…
Hepatic encephalopathy encompasses a spectrum of neuropsychiatric abnormalities that occur in patients with liver disease in the absence of other brain disease. , The spectrum includes personality changes, impaired mental function, motor abnormalities (i.e., asterixis, tremors, hyperventilation, hyperactive reflexes), and…