Influence of gut function, on SIRS and clinical outcomes in surgical patients

Background: The GI tract is a highly complex organ system with multitude of functions. Gastrointestinal dysfunction remains an unrecognised clinical entity in day to day clinical practice hence it is possible many patients are inadequately managed resulting in poorer clinical outcomes. Recognising gut failure and early initiation of gut directed therapies may influence clinical outcomes.Aims: This thesis aims to review available literature for importance of gut function and its influence on SIRS and clinical outcomes and investigate the state of gut function and its influence on SIRS and clinical outcomes in surgical patients, further develop a method to optimise gut function and test the influence of this optimisation package on clinical outcomes in elective surgical patients.Methods: A series of clinical studies in elective surgical patients to investigate the influence of gut function on clinical outcomes.Results: Inadequate gut function was common in patients with pancreatitis and the persistent gut failure was associated with SIRS, MODS and poorer clinical outcomes. Critically ill patients with gut failure had increased prevalence of SIRS however this has not resulted in increased mortality or poorer clinical outcome. Elective GI surgical patients developed gut dysfunction in the post operative period more commonly than patients who underwent breast surgery and this was associated with increased prevalence of SIRS and septic morbidity. Optimisation of gut function was associated with early return of gut function and improved clinical outcomes in elective surgical patients.Conclusion: Recognition of gut failure is important in day to day clinical practice and gut failure is associated with poorer outcomes in surgical patients. Gut directed therapy to optimise gut function is associated with improved clinical outcomes.

Name dc:type.qualificationname

MD

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Hull

Year dc:date.issued

2012

Author dc:creator

• Kallam, Ramana Reddy

Advisor dc:contributor.advisor

• MacFie, John

• Medicine

Language dc:language

en

Identifier

oai:hull-repository.worktribe.com:4214926

OAI identifier oai:identifier

oai:hull-repository.worktribe.com:4214926