Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter X: Compensatory and Pathophysiological Responses to Trauma

Gastrointestinal Subsystem

United States Department of Defense

Preferential redistribution of blood flow in the shock state results in splanchnic ischemia. The ischemic mucosal insult can subsequently result in gastric stress ulceration, especially in the presence of associated sepsis. Gastrointestinal hemorrhage of significant degree is usually the presenting symptom. The onset of bleeding usually presents about ten days post injury. These gastric ulcerations are frequently multiple. Perforation can occur. Prophylactic therapy consists of antacid buffering of the gastric content, and administration of a histamine hydrogen receptor antagonist, such as cimetidine. Enteral alimentation is also thought to provide gastric mucosal protection and should be instituted when feasible.

Intractable upper gastrointestinal hemorrhage from stress ulceration may require gastric resection or vagotomy and pyloroplasty. Perforation is another indication for operative intervention.

Acalculous cholecystitis may occur in trauma victims at a time when it is most difficult to diagnose. Presumably, it develops under the conditions of dehydration or lack of stimulation by oral intake, or from the effects of drugs. All of the foregoing occur in trauma casualties, oftentimes in association with abdominal wounds. It may mimic other more common conditions following trauma, and may progresses to gangrenous cholecystitis and rupture before it is suspected.

The generalized ileus usually seen in the shock state necessitates nasogastric decompression to prevent emesis and possible aspiration.

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Operational Medicine 2001

Health Care in Military Settings

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