Review文献2011 A review of stress-related mucosal disease.pdfVIP

Clinical Practice Review Journal of Veterinary Emergency and Critical Care 21(5) 2011, pp 484–495 doi: 10.1111/j.1476-4431.2011.00680.x A review of stress-related mucosal disease Andrea A. Monnig, DVM and Jennifer E. Prittie, DVM, DACVIM, DACVECC Abstract Objective – To review and summarize the human and veterinary literature regarding stress-related mucosal disease (SRMD) pathogenesis, patient risk factors, and therapeutic options for prophylaxis and treatment. Etiology – SRMD is a common sequela of critical illness in human patients. Development of SRMD results from splanchnic hypoperfusion, reperfusion injury, and exposure of the gastric mucosa to acid, pepsin, and bile acids following breakdown of the gastric mucosal defense system. Human patients with the highest risk of stress ulceration include those with respiratory failure necessitating mechanical ventilation greater than 48 h or coagulopathy. Currently, little is known about the incidence and pathophysiology of SRMD in critically ill veterinary patients. Diagnosis – A presumptive diagnosis can be made in high-risk patient populations following detection of occult or gross blood in nasogastric tube aspirates, hematemesis, or melena. Definitive diagnosis is achieved via esophagogastroduodenoscopy. Lesions are localized to the acid-producing portions of the stomach, the fundus, and body. Therapy – Therapy is aimed at optimization of tissue perfusion and oxygenation. Pharmacologic interven- tions are instituted to increase intraluminal pH and augment natural gastric defenses. Histamine2 -receptor antagonists, proton pump inhibitors, and