Gastrointestinal Response
Adynamic ileus, gastric dilatation, increased gastric
secretion and ulcer incidence, gastrointestinal
hemorrhage and local and general distribution of the
blood flow with a decrease of mesenteric blood flow are
among the effects of thermal injury on the
gastrointestinal system (53). A decrease in mesenteric
blood flow has been described in a number of burn and
smoke inhalation animal models, even in the absence of
any evidence of inadequate systemic perfusion (54). The
effect of acute burn trauma, produced by hot water
scalding in the rat, has demonstrated that there is
decreased nutrient absorption (glucose, calcium and
amino acids) and DNA synthesis in the small intestine
(55). The burn patient has been found to have a high
incidence of ulcers. Erosion of the stomach lining and
duodenum has been demonstrated in 86% of major burn
patients within 72 h of injury, with more than 40% of
patients having gastrointestinal bleeding (56). In
addition, the process of increased bacterial translocation
and macromolecular leak have been well documented
after burn injury, being evident in humans as well (57-
60). Intestinal ischemia resulting from decreased
splanchnic blood flow may activate the neutrophils and
tissue-bound enzymes such as xanthine oxidase and these
factors destroy the gut mucosal barrier and result in
bacterial translocation. These data indicate an early
postburn gut barrier leak after the burn, which may be
the source of circulating endotoxin (61).
Gastrointestinal ResponseAdynamic ileus, gastric dilatation, increased gastricsecretion and ulcer incidence, gastrointestinalhemorrhage and local and general distribution of theblood flow with a decrease of mesenteric blood flow areamong the effects of thermal injury on thegastrointestinal system (53). A decrease in mesentericblood flow has been described in a number of burn andsmoke inhalation animal models, even in the absence ofany evidence of inadequate systemic perfusion (54). Theeffect of acute burn trauma, produced by hot waterscalding in the rat, has demonstrated that there isdecreased nutrient absorption (glucose, calcium andamino acids) and DNA synthesis in the small intestine(55). The burn patient has been found to have a highincidence of ulcers. Erosion of the stomach lining andduodenum has been demonstrated in 86% of major burnpatients within 72 h of injury, with more than 40% ofpatients having gastrointestinal bleeding (56). Inaddition, the process of increased bacterial translocationand macromolecular leak have been well documentedafter burn injury, being evident in humans as well (57-60). Intestinal ischemia resulting from decreasedsplanchnic blood flow may activate the neutrophils andtissue-bound enzymes such as xanthine oxidase and thesefactors destroy the gut mucosal barrier and result inbacterial translocation. These data indicate an earlypostburn gut barrier leak after the burn, which may bethe source of circulating endotoxin (61).
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