Which of the following statements about the role of the gut in shock and sepsis are true?

B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of the gut.

C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of MODS by the mechanism of bacterial translocation.

D. As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

 DISCUSSION: The gut has a vital role in the pathophysiology of shock. The splanchnic circulation is very vulnerable to the circulatory redistribution that occurs in shock, thus, gut ischemia may occur early in the various shock syndromes. Gut injury, as a result of ischemia or reperfusion injury, leads to disruption in the intestinal mucosal barrier and increased gut permeability. Translocation of enteric flora or bacterial toxins across the gut wall may then occur, resulting in amplification of the systemic inflammatory response and the development of multiple organ dysfunction. Gut dysfunction, therefore, may perpetuate the inflammatory process. Various methods have been tried to modulate the deleterious effects of gut dysfunction. Selective decontamination of the digestive tract by oral antibiotics has been shown to reduce the incidence of nosocomial pneumonias, but no improvement in mortality has been demonstrated thus far with this controversial technique. Early enteral nutrition probably has the biggest impact on the preservation of gut architecture and function. When compared to parenteral nutrition, enteral feeding is more cost effective and is associated with a lower rate of septic morbidity.