AI Article Synopsis
- The study focuses on key aspects of clinical exams and management for surgical abdomen issues in critically ill patients, highlighting relevant investigations and treatment strategies.
- Recent findings indicate that while lactate is not a definitive marker for gut ischemia, advanced imaging techniques like dual energy CT can aid in diagnosis, and new endovascular treatments are emerging to reduce the need for invasive surgery.
- The research emphasizes the importance of physical examinations, timely surgical interventions, and collaboration between intensivists and surgeons to enhance patient outcomes in critical situations.
Article Abstract
Purpose Of Review: The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill.
Recent Findings: Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approaches, including catheter-directed thrombolysis, may decrease need for laparotomy in the appropriate patient. Nonocclusive mesenteric ischemia remains a challenging diagnostic and management dilemma. Acalculous cholecystitis is managed with a percutaneous cholecystostomy and is unlikely to require interval cholecystectomy. Surgeon comfort with intervention based on point-of-care ultrasound for biliary disease is variable. Mortality for toxic megacolon is decreasing.
Summary: Physical examination remains an integral part of the evaluation of the surgical abdomen. Interpreting laboratory investigations in context and appropriate imaging improves diagnostic ability; intravenous contrast should not be withheld for critically ill patients with acute kidney injury. Surgical intervention should not be delayed for the patient in extremis. The intensivist and surgeon should remain in close communication to optimize care.
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| http://dx.doi.org/10.1097/MCC.0000000000000783 | DOI Listing |
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