Hepatic Failure/GI/Endocrine Emergencies

Patient Case

A 34-year-old woman with morbid obesity presents to the surgical ICU after gastric bypass surgery 1 week

prior with an enterocutaneous fistula requiring medical management. Her current output is about 600 mL/

day. For the patient’s high-output fistula, which best represents the intervention that has not been associated

with a reduction in fistula output volume?

Incidence of POI can vary, depending on the type of procedure:

Abdominal hysterectomy: About 3%

Bowel resection: About 15%

increased postoperative pain, PONV, and risk of postoperative complications (e.g., aspiration

pneumonia, thromboembolism, nosocomial infection).

POI is a transient impairment of appropriate GI motility after a surgical procedure.

small intestine, or large intestine.

The duration of POI is typically 2–3 days after a procedure, but POI may last up to 6 days postoperatively.

Return to normal bowel function is monitored using objective signs such as passing of flatus, active

bowel sounds, or a bowel movement.

The duration of POI often depends on the surgical site. Return to normal function is fastest for

the small bowel, normally within 24 hours. Paralytic state may last on average 24–48 hours in the

stomach, whereas it may take up to 3–5 days for the colon to return to normal function.

If POI persists beyond about 6 days, it is called a paralytic ileus.

Bowel motility is controlled by the autonomic nervous system. Parasympathetic stimulation increases

bowel motility, whereas sympathetic stimulation inhibits it.

Increased sympathetic output postoperatively may lead to increased ileus formation. The colon is

more dependent on the autonomic nervous system than the stomach or small intestine, which may

explain the longer recovery time postoperatively.

The vagal nerve is important to parasympathetic activity in the stomach. Inadvertent damage to the

vagal nerve during abdominal surgery can result in impaired emptying of the stomach.