[Significance of perfusion of the gastrointestinal tract in shock]

The splanchnic perfusion is reduced early in the course of any shock. The mucosa of the gut suffers most as it experiences a high oxygen demand even in the steady state. The specific arrangement of the micro vessels within the villus of the mucosa exposes the tip of the villus at the highest risk for ischemia, particularly in low flow states. As a consequence the integrity of the mucosal layer is compromised and dysfunction of the mucosal barrier may allow bacteria and toxins to translocate from the gut lumen. Activation of leukocytes and stimulation of cytokine synthesis may comprise a sustained inflammatory response syndrome. So far there is a good body of evidence that the splanchnic region may play an important role in the pathophysiological sequence from shock to organ dysfunction.