Skip to main content
SpringerLink
Log in

Gastrointestinal Mucosal Ischemia

  • Chapter
Gut Dysfunction in Critical Illness

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 26))

Abstract

Beginning in the esophagus and continuing all the way to the anus, the wall of the digestive tube has the same basic arrangement of four layers. The four basic layers present are, from the lumen of the gut outward: the mucosa, the submucosa, the muscularis and the serosa. The mucosa is the mucous membrane that lines the digestive tract. It consists of three layers: an epithelial layer, the lamina propria, the muscularis mucosa. The submucosa contains blood vessels, lymphatics, nerves, and in some regions glands. The microcirculation of the alimentary tract is crucial not only for the nutritive maintenance of the alimentary tract itself, but also for its vital functions of secretion and absorption, since the circulation is the ultimate source of the secreted digestive juices and the recipient of absorbed digesta. Moreover, the integrity of mucosal barrier function is thought to play an important role in defending the host from translocation of intact micro-organisms or their breakdown products and toxins [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Wells C, Maddaus M, Simmons R (1988) Proposed mechanisms for the translocation of intestinal bacteria. Rev Infectious Dis 10: 958–979

    Article  CAS  Google Scholar 

  2. Gannon B, Browning J, O’Brien P, Rogers P (1984) Mucosal microvascular architecture of the fundus and body of human stomach. Gastroenterology 86: 866–875

    PubMed  CAS  Google Scholar 

  3. Landow L, Andersen LW (1994) Splanchnic ischemia and its role in multiple organ failure. Acta Anaesth Scand 38: 626–639

    Article  PubMed  CAS  Google Scholar 

  4. Bailey RW, Bulkley GB, Levy KI, et al (1982) Pathogenesis of nonocclusive mesenteric ischemia: Study in a porcine model induced by pericardial tamponade. Surg Forum 33: 194–197

    Google Scholar 

  5. Porter JM, Sussman MS, Bulkley GB (1989) Splanchnic vasospasm in circulatory shock. In: Marston A, Bulkley GB, Fiddian-Green RG, et al (eds) Splanchnic ischemia and multiple organ failure. E Arnold, London, pp 73–88

    Google Scholar 

  6. Bailey RW, Bulkley GB, Hamilton SR, et al (1987) Protection of the small intestine from non-occlusive mesenteric ischemic injury due to cardiogenic shock. Am J Surg 153: 108–116

    Article  PubMed  CAS  Google Scholar 

  7. McNeil JR, Stark RD, Greenway CV (1970) Intestinal vasoconstriction after hemorrhage: Roles of vasopressin and angiotensin. Am J Physiol 219: 1342–1347

    Google Scholar 

  8. Schlichtig R, Kramer DJ, Pinsky MR (1991) Flow redistribution during progressive hemorrhage is a determinant of critical O2 delivery. J Appl Physiol 70:169–178

    PubMed  CAS  Google Scholar 

  9. Edouard AR, Degrémont AC, Duranteau J, Pussard E, Berdeaux A, Samii K (1994) Heterogeneous regional vascular responses to simulated transient hypovolemia in man. Intensive Care Med 20: 414–420

    Article  PubMed  CAS  Google Scholar 

  10. Duranteau J, Sitbon P, Vicaut E, Descorps-Declère A, Vigue B, Samii K (1996) Assessment of gastric mucosal perfusion during simulated hypovolemia in healthy volunteers. Am J Respir Crit Care Med (In press)

    Google Scholar 

  11. Hartmann M, Montgomery A, Jonsson K, et al (1991) Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tension, and GI intramucosal pH in pigs. Crit Care Med 19: 205–210

    Article  PubMed  CAS  Google Scholar 

  12. Grum CM, Fiddian-Green RG, Pittenger GL, et al (1984) Adequacy of tissue oxygenation in intact dog intestine. J Appl Physiol 56: 1065–1069

    PubMed  CAS  Google Scholar 

  13. Schlichtig R, Bowles SA (1994) Distinguishing between aerobic and anaerobic appearance of dissolved CO2 in intestine during low flow. J Appl Physiol 76: 2443–2451

    PubMed  CAS  Google Scholar 

  14. Tang W, Weil MH, Sun S, Noc M, Gazmuri R, Bisera J (1994) Gastric intramural PCO2 as monitor of perfusion failure during hemorrhagic and anaphylactic shock. J Appl Physiol 76: 572–577

    PubMed  CAS  Google Scholar 

  15. Haglund U, Bulkley G, Granger D (1987) On the pathophysiology of intestinal ischemic injury. Acta Chir Scand 153: 321–324

    PubMed  CAS  Google Scholar 

  16. Curtis SE, Cain SM (1992) Systemic and regional O2 delivery and uptake in bled dogs given hypertonic saline, whole blood, or dextran. Am J Physiol 262: 778–786

    Google Scholar 

  17. Salzman A, Wollert PS, Wang H, et al (1993) Intraluminal oxygenation ameliorates ischemia/reperfusion-induced gut mucosal hyperpermeability in pigs. Circ Shock 40: 37–46

    PubMed  CAS  Google Scholar 

  18. Whittle BJR (1993) Neuronal and endothelium-derived mediators in the modulation of gastric microcirculation: Integrity in the balance. Br J Pharmacol 110: 3–17

    PubMed  CAS  Google Scholar 

  19. Jutabha R, Poa L, Jensen DM (1995) Stress ulceration in the critically ill. Curr Opin Crit Care 1: 125–129

    Article  Google Scholar 

  20. Nash J, Lambert L, Deakin M (1994) Histamine H2-receptor antagonists in peptic ulcer disease. Evidence for a prophylactic use. Drugs 47: 862–871

    Article  PubMed  CAS  Google Scholar 

  21. Chamberlain CE (1993) Acute hemorrhagic gastritis. Gastroenterol Clin N Am 22: 843–873

    CAS  Google Scholar 

  22. Stannard VA, Hutchinson A, Morris DL, Byrne A (1988) Gastric exocrine failure in critically ill patients: Incidence and associated features. Br Med J 296: 155–156

    Article  CAS  Google Scholar 

  23. Urakawa T, Nagahata Y, Azumi Y, et al (1989) The mechanism of acute gastric ulcer after induced hemorrhagic shock. Scand J Gastroenterol 24: 193–201

    Article  PubMed  CAS  Google Scholar 

  24. Tryba M, Kulka PJ (1993) Critical care pharmacology. A review. Drugs 45: 338–352

    Article  PubMed  CAS  Google Scholar 

  25. Whittle BJR (1983) The potentiation of taurocholate-induced rat gastric erosions following parenteral administration of cyclooxygenase inhibitors. Br J Pharmacol 80: 545–551

    PubMed  CAS  Google Scholar 

  26. Fiddian-Green RG, McGough E, Pittenger G, Rothman E (1983) Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 85: 613–620

    PubMed  CAS  Google Scholar 

  27. Fusamoto H, Hagiwara H, Meren H, et al (1991) A clinical study of acute gastrointestinal hemorrhage associated with various shock states. Am J Gastroenterol 86: 429–433

    PubMed  CAS  Google Scholar 

  28. Cook DJ, Fuller HD, Guyat GH, et al (1994) Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330: 377–381

    Article  PubMed  CAS  Google Scholar 

  29. Tokyay R, Zeigler S, Traber DL, et al (1993) Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation. J Appl Physiol 74: 1521–1527

    Article  PubMed  CAS  Google Scholar 

  30. Vallet B, Lund N, Curtis SE, et al (1994) Gut and muscle tissue PO2 in endotoxemic dogs during shock and resuscitation. J Appl Physiol 76: 793–800

    PubMed  CAS  Google Scholar 

  31. Payne JG, Bowen JC (1981) Hypoxia of canine gastric mucosa caused by E. coli sepsis and prevented with methylprednisolone therapy. Gastroenterology 80: 84–93

    PubMed  CAS  Google Scholar 

  32. Thorborg P, Malmqvist LA, Lund N (1988) Surface oxygen pressure distributions in rabbit skeletal muscle: Dependence on arterial PO2. Microcirc Endothel Lymphatics 4: 169–192

    CAS  Google Scholar 

  33. Gutierrez G, Lund N, Palizas F (1991) Rabbit skeletal muscle PO2 during hypodynamic sepsis. Chest 99: 224–229

    Article  PubMed  CAS  Google Scholar 

  34. Curtis SE, Cain SM (1992) Regional and systemic oxygen delivery/uptake relations and lactate flux in hyperdynamic, endotoxin-treated dogs. Am Rev Respir Dis 145: 348–354

    PubMed  CAS  Google Scholar 

  35. Dodd SL, King CE, Cain SM (1987) Responses of innervated and denervated gut to whole body hypoxia. J Appl Physiol 62: 651–657

    PubMed  CAS  Google Scholar 

  36. Montgomery A, Hartmann M, Jonsson K, Haglund UH (1989) Intramucosal pH measurement with tonometer for detecting gastrointestinal ischemia in porcine hemorrhagic shock. Circ Shock 29: 319–327

    PubMed  CAS  Google Scholar 

  37. Drazenovic R, Samsel RW, Wylam ME, Doerschuk CM, Schumacker PT (1999) Regulation of perfused capillary density in canine mucosa during endotoxemia. J Appl Physiol 72: 259–265

    Google Scholar 

  38. Whitworth PW, Cryer HM, Garrisson RN, et al (1989) Hypoperfusion of the intestinal microcirculation without decreased cardiac output during live Escherichia coli in rats. Circ Shock 27: 111–122

    PubMed  CAS  Google Scholar 

  39. Theuer CJ, Wilson MA, Steeb GD, et al (1993) Microvascular vasoconstriction and mucosal hypoperfusion of the rat small intestine during bacteremia. Circ Shock 40: 61–68

    PubMed  CAS  Google Scholar 

  40. Nevière R, Chagnon LJ, Vallet B, et al (1995) Gut oxygenation in endotoxemic pigs during shock and resuscitation. Intensive Care Med 21: S18 (Abst)

    Article  Google Scholar 

  41. Shepherd AP (1980) Intestinal blood flow autoregulation during foodstuff absorption. Am J Physiol 239: H156–H162

    PubMed  CAS  Google Scholar 

  42. Breslow MJ, Miller CF, Parker SD, et al (1987) Effect of vasopressors on organ blood flow during endotoxin shock in pigs. Am J Physiol 252: H291–H300

    PubMed  CAS  Google Scholar 

  43. Schneider AJ, Groeneveld AB, Teule GJ, et al (1991) Total body blood volume redistribution in porcine E. coli septic shock. Circ Shock 35: 215–222

    PubMed  CAS  Google Scholar 

  44. Bersten AD, Hersch M, Cheung H, et al (1992) The effect of various sympathomimetics on the regional circulations in hyperdynamic sepsis. Surgery 112: 549–561

    PubMed  CAS  Google Scholar 

  45. Falk A, Redfors S, Myrvold H, et al (1985) Small intestinal mucosal lesions in feline septic shock: A study on the pathogenesis. Circ Shock 17: 327–337

    PubMed  CAS  Google Scholar 

  46. Fink MP, Antonsson JB, Wang H, et al (1991) Increased intestinal permeability in endotoxic pigs. Arch Surg 126: 211–218

    Article  PubMed  CAS  Google Scholar 

  47. Fink MP, Kaups KL, Wang H, et al (1991) Maintenance of superior mesenteric arterial perfusion prevents increased intestinal mucosal permeablity in endotoxic pigs. Surgery 110: 154–161

    PubMed  CAS  Google Scholar 

  48. Shepherd AP, Riedel GL, Maxwell LC, et al (1984) Selective vasodilators redistribute intestinal blood flow and depress oxygen uptake. Am J Physiol 247: G377–G384

    PubMed  CAS  Google Scholar 

  49. Cain SM, Curtis SE (1992) Systemic and regional oxygen uptake and lactate flux in endotoxic dogs resuscitated with dextran and dopexamine or dextran alone. Circ Shock 38: 173–181

    PubMed  CAS  Google Scholar 

  50. Fiddian-Green RG (1995) Gastric intramucosal pH, tissue oxygenation and acid-base balance. Br J Anaesth 74: 591–606

    Article  PubMed  CAS  Google Scholar 

  51. Silverman HJ, Tuma P (1992) Gastric tonometry in patients with sepsis: Effects of dobuta-mine infusion and packed red blood cell transfusions. Chest 102: 184–188

    Article  PubMed  CAS  Google Scholar 

  52. Marik PE, Sibbald WJ (1993) The effect of stored blood transfusion on oxygen delivery in patients with sepsis. JAMA 269: 3024–3029

    Article  PubMed  CAS  Google Scholar 

  53. Smithies M, Yee TH, Jackson L, et al (1994) Protecting the gut and the liver in the critically ill: Effects of dopexamine. Crit Care Med 22: 789–795

    Article  PubMed  CAS  Google Scholar 

  54. Gutierrez G, Clark C, Brown SD, et al (1994) Effect of dobutamine on oxygen consumption and gastric mucosal pH in septic patients. Am J Respir Crit Care Med 150:324–329

    PubMed  CAS  Google Scholar 

  55. Nevière R, Chagnon JL, Mathieu D, et al (1995) Effects of dobutamine and dopamine on gastric mucosal blood flow in septic patients. Am J Respir Crit Care Med 151: A446 (Abst)

    Google Scholar 

  56. Levy B, Bollaert PE, Nace L, Charpentier C, Bauer PH, Larcan A (1995) Epinephrine or norepinephrine-dobutamine for dopamine resistant septic shock. Am J Respir Crit Care Med 151: A447 (Abst)

    Google Scholar 

  57. Radermacher P, Buhl R, Santak B, et al (1995) The effects of prostacyclin on gastric intramucosal pH in patients with septic shock. Intensive Care Med 21: 414–421

    Article  PubMed  CAS  Google Scholar 

  58. Gutierrez G, Palizas F, Doglio G, et al (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339: 195–199

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. B. Vallet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Nevière
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. L. Chagnon
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, Pennsylvania University Hospital, 3400 Spruce Street, 19104, Philadelphia, PA, USA

    J. L. Rombeau

  2. Department of Intensive Care Critical Care Research Program, Kuopio University Hospital, FIN-70211, Kuopio, Finland

    J. Takala

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Vallet, B., Nevière, R., Chagnon, J.L. (1996). Gastrointestinal Mucosal Ischemia. In: Rombeau, J.L., Takala, J. (eds) Gut Dysfunction in Critical Illness. Update in Intensive Care and Emergency Medicine, vol 26. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80224-9_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-80224-9_16

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-80226-3

  • Online ISBN: 978-3-642-80224-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation