الفهرس 
PATHOPHYSIOLOGY OF GASTROINTESTINAL COMPLICATIONS POST-CARDIAC SURGERYOnly 14 pages are availabe for public view
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Abstract
Gastrointestinal complications after cardiac operations, although rare, often carry an increased mortality.
Abdominal complications after cardiac surgery include, paralytic ileus, gastrointestinal haemorrhage, gastroduodenal perforation, acute acalcular cholecystitis, hepatic dysfunction and ischemic bowel disease, acute pancreatitis and pseudomembranous colitis.
Although overt injury of the intra-abdominal organs after cardiac surgery is relatively uncommon, when it occurs, it is associated with a high mortality and thus accounts for a significant and perhaps increasing fraction of postoperative deaths.
Despite the deterioration of the risk profile of patients presenting for cardiac surgery, the overall incidence of gastrointestinal complications has improved over the last two decades, which may be a result of improvements in cardiac surgical techniques, anaesthesia and intensive care.
A common theme among these complications is the difficulty in making an early diagnosis. The majority of these patients are mechanically ventilated, requiring sedation and often receiving pharmacologic cardiovascular support. Because of these factors, physical exam is frequently unreliable and some of the diagnostic tools, such as CT scans, are difficult to obtain due to the instability of the patient.
In order to avoid delayed diagnosis, clinical testing should be initiated with laboratory evaluation and imaging when a high-risk patient deviates from the expected postoperative course. Low cardiac output syndrome, prolonged inotropic pressor requirement or SIRS are especially associated with GI complications. Use of ultrasound, CT scan, endoscopy, angiography, or laparoscopy should be considered without delay. It is important that a general surgeon be involved early. Although the cardiac condition of these patients should be considered, most will have improved cardiac perfusion in the postoperative period and will be able to withstand general anesthesia and an abdominal operation if deemed necessary. The risk for a delay in diagnosis and nonoperative management when operation is indicated carries a high mortality.
In summary, GI complications after cardiac surgery are rare events that may be difficult to diagnose and treat. Unfortunately few of the risk factors for complications are specific, and they are often general signs of sicker patients. The challenge is to design a reproducible risk stratification formula to identify patients at risk for certain complications.