الفهرس 
Anatomy of IntestineOnly 14 pages are availabe for public view
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Abstract
Diarrhea and constipation are the most common nonhemorrhagic bowel disturbances seen in ICU patients. Diarrhea can be defined as increased stool frequency (more than three bowel movements per day), liquidity of feces or stool weight of more than 200-300 g/24 h.
Diarrhea occurs in 20% to 30% of patients in the intensive care unit (ICU). It may result in sever fluid and electrolytes imbalance, leading to prolonged stay in ICUs. The most common causes of diarrhea in ICU patients are medications, antibiotics, and tube feeding (63% of cases).
Clostridium difficile infection may develop in approximately 15% to 20% of cases of antibiotic-associated diarrhea, which can present as mild watery diarrhea up to life threatening pseudomembranous colitis that can progress to toxic megacolon or perforation, requiring urgent surgical intervention. It is caused by various medications, particularly antibiotics such as clindamycin, penicillins, broad spectrum cephalosporins and fluoroquinolones.
The treatment of the diarrhea will depend on the cause and severity of the diarrhea. If medications are responsible for causing the diarrhea, they should be stopped or changed. Diarrhea caused by tube feedings may be treated by changing the tube feeding formula, temporarily decreasing the amount of tube feeding given, adding fiber to the tube feeding, or stopping the tube feeding and intravenous feeding may be required. If the diarrhea is caused by a Clostridium difficle infection, antibiotics will be necessary to treat this type of diarrhea.
Constipation is a symptom rather than a disease and it is usually defined as difficulty during defecation, less than 3 bowel movements per week, or there may be a sensation of incomplete bowel evacuation. It is a common complication identified among critically ill patients. The incidence in ICUs patients varies widely, between 5% and 83%.
Besides the already known consequences of constipation such as abdominal discomfort and cramps, in recent years it was observed that it may also be related to worse prognosis of critically ill patients, as it was noted that 42% of constipated patients failed to wean from mechanical ventilation with prolonged stay in ICUs.
The etiology of constipation is usually multifactorial, but it can be divided into 2 main groups, primary constipation and secondary constipation. There are psychological and physiological factors increasing the chance of constipation in ICU patients. Among these causes, Ogilvie’s syndrome and opioids induced constipation must be emphasized.
Initial treatment consists of lifestyle modification and laxatives. Medical treatment should be tailored to the underlying etiology. Patients who do not respond to medical treatment may need specialized evaluation for pelvic floor dysfunction and biofeedback therapy. Surgery is only indicated in severe cases.