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The Initial Metabolic Medicine Hospital Consult
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
For the first example, I might say something to the effect of: This is a 52-year-old male with a known history of head and neck cancer who is status post-surgery, radiation and chemotherapy. He has developed a progressive dysphagia and currently presents with a complete inability to swallow. He has lost approximately 50 pounds since the onset of his illness. Both GI and Interventional Radiology were unable to place a percutaneous endoscopic gastrostomy (PEG). He is scheduled for a surgical gastrostomy next week.His nutritional diagnosis is that of severe protein-calorie malnutrition, present on admission (POA). The diagnosis and degree are supported by his complete inability to consume food for more than 5 days, his significant weight loss and the presence of muscle wasting and fat depletion throughout the body. He also has diminished circulating proteins as evidenced by a low total protein, albumin and prealbumin.
Treatment – Chronic Illness-Related Malnutrition
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Jennifer Doley, Michelle Bratton
Oral nutrition, including the use of ONS, is usually considered the first line of therapy in managing malnutrition; however, when oral intake remains inadequate, or when swallowing function is unsafe or impaired, an individual may require EN. Enteral nutrition is the preferred method of nutrition support in the setting of a functioning GI tract because it is necessary to maintain gut function, thus preventing bacterial translocation and supporting immune health; it is a more physiological approach to feeding and is less expensive than PN. Most patients on EN are EN-dependent for less than one month, in which case a nasoenteric tube is the preferred method of delivery.29 If oral intake is anticipated to be inadequate for more than four to six weeks, a gastrostomy tube should be considered.30
Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Management of respiratory symptoms remains the determinant of outcome. A gastrostomy is often inserted if the patient is unable to maintain body weight or if there is frank dysphagia. Hypoxemia or hypercapnia is an important indication for noninvasive ventilation, and most patients are able to tolerate noninvasive ventilation quite well. Noninvasive ventilation improves hypoxemia and hypercapnia, although it rarely normalizes these values.
Technical aspects and standardization of the totally robotic Roux-en-Y gastric bypass. Results of a single surgeon experience with a 5-year follow-up
Published in Acta Chirurgica Belgica, 2022
Emmelie Reynvoet, Veerle Van Vlodrop, Kurt Hendrick, Dries Vandeweyer, Carlos Vaz
The gastric tube is pushed until the end of the pouch. With the coagulation hook a gastrostomy is created by coagulation directly on the tube to avoid double layer burning. The tube is pushed through the gastrostomy and the diameter of the tube is used as marker for the length of the incision on the pouch. An even-sized incision is made on the jejunal limb. The inner layer of the anastomosis is performed with the prefab knotted sutures Vicryl 3/0 (Figure 6(2)). At this moment, two needle drivers are used. The knot of the sutures is positioned inside the gastric pouch at its lateral corner. When performing this suture traction is performed on the first suture to align the anastomosis. Then the posterior layer is sewed first from lateral to medial making vertical stitches. Thereafter the anterior layer is sewed and before total closure of the anastomosis the bougie is pushed across the anastomosis to enhance correct calibration (Figure 6(3)). Finally, the outer layer of the anterior side is closed with the same 30 cm Vicryl 3/0 suture, from lateral to medial using horizontal oriented stiches this time (Figure 6(4)). Once the double layered suture is concluded an opening is made in the mesentery of the biliopancreatic limb. A stapler is introduced, and the limb is stapled at a maximum distance of 1.5 cm of the anastomosis.
Percutaneous gastrostomy in amyotrophic lateral sclerosis: a review
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2022
AndrÉ Castanheira, Michael Swash, Mamede De Carvalho
The protocol and report of this study followed the PRISMA guidelines (20), and the original protocol was updated according to reviewers’ suggestions. We searched Pubmed, Google Scholar, and Cochrane databases. The following research terms were used: percutaneous endoscopic gastrostomy (PEG), RIG, PRG, radiologically inserted gastrostomy, PIG, per-oral image-guided gastrostomy, PEG-J, percutaneous gastrojejunostomy, gastrostomy, nasogastric tube, nasogastric feeding, NGT, ALS, MND, and motor neuron disease. The search was restricted to articles published in English, without a time limit. Identification of additional papers was made through handsearching published reviews and original studies on the subject. The inclusion criteria included studies of patients with a diagnosis of ALS, after gastrostomy and nasogastric tube insertion, including randomized clinical trials or cohort studies, with a retrospective or prospective design. Studies with sample sizes less than 40 or with a specific gastrostomy technique used in less than 30 patients were excluded in order to avoid small samples bias.
Emerging drugs for the treatment of epidermolysis bullosa
Published in Expert Opinion on Emerging Drugs, 2020
Matthias Titeux, Mathilde Bonnet des Claustres, Araksya Izmiryan, Helene Ragot, Alain Hovnanian
Gastrointestinal tract complications are most commonly seen in RDEB but can also be present in EBS and JEB subtypes. They contribute to nutritional compromise. Painful dysphagia resulting from the acute blistering of the pharynx or esophagus is treated with systemic corticosteroids. Esophageal strictures are ideally treated by fluoroscopically guided balloon dilatation. However, recurrence of strictures after dilatation is frequent. Gastroesophageal reflux disease usually responds to Histamine 2 – blockers, proton pump inhibitors or pro-motility agents. Growth retardation is common and is thought to occur from insufficient oral intake, increased energy expenditure and malabsorption. Gastrostomy feeding may be necessary to maintain adequate nutrition. Constipation is frequent and alleviation requires adequate fluid and dietary fiber intake, mineral oil, lactulose, osmotic and stimulant laxatives. Pyloric atresia seen in EB with pyloric atresia (EB-PA) is treated by early surgical correction.