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Parenteral and Enteral Nutrition in Critical Illness
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Despite this knowledge and our best of intentions, there are many clinical conditions where it is simply impossible to utilize the gut for nutrition. The effects of surgery, treatment, disease and trauma may create ileus, gastroparesis, abdominal distention and diarrhea. This can create a scenario in which enteral feeding cannot be expected to provide sufficient energy and protein intake, leaving the patient with an accumulating nutritional deficit. The pictorial version of parental and enteral feeding is in Figure 14.7.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
An ileus can be described as a reduction in gastrointestinal motility not caused by mechanical obstruction. It commonly follows operative management involving laparotomy rather than laparoscopy, and can typically last 48–72 hours, however in many cases this period can be significantly prolonged. Treatment is centred around keeping patients nil by mouth in order to rest the gut, allow for the identification of precipitating factors and continue supportive therapy. Iatrogenic factors are a common culprit and often replacing opiate-based analgesic with NSAIDs helps to prevent a worsening ileus. Other treatment options include early enteral feeding and ambulation. Other important causative factors to consider include: Electrolyte disturbancesInflammatory responsesIatrogenic compounds such as analgesic, anticholinergics and anaesthesiaAcute or systemic disease, e.g. acute cholecystitis, myocardial infarction pancreatitis and sepsisMulti-organ trauma
Motility disorders
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
The mainstay of treatment of established postoperative ileus is supportive. Intravenous hydration and correction of any metabolic abnormalities are vital. Nasogastric intubation remains the only effective therapy.116 No specific drug therapy has been shown to be effective in double-blind trials.
Comparison of surgical gloves: perforation, satisfaction and manual dexterity
Published in International Journal of Occupational Safety and Ergonomics, 2022
Tulay Basak, Gul Sahin, Ayla Demirtas
An observational, prospective study was performed during April–May 2018. Scrub nurses used specified gloves during nine selected surgeries: (a) total hip prosthesis or total knee prosthesis; (b) lumbar laminectomy; (c) vitrectomy; (d) transurethral resection of the prostate or ureterorenoscopy; (e) ileus surgery; (f) caesarean section; (g) graft-flap surgeries; (h) video-assisted thoracoscopic surgery (VATS); (i) appendectomy surgery. We determined the cases by taking the frequencies of procedures into consideration in our hospital. A homogeneous number for the surgeries is aimed at mostly operative clinics in our hospital. scrub nurses wore antiallergenic surgical (powder and latex free). Also use powder and latex free gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. Within the scope of the study, each type of glove was used in each of nine operations. All gloves were worn 105 times by 35 nurses. Thus, the effectiveness of all types of gloves was examined 315 times in total (Figure 1). If the gloves were visibly perforated during surgery, they were immediately replaced with new gloves of the same type and size. The number of punctured gloves was recorded. Among the scrub nurses, 60% were women and 40% were men.
Can maneuverability in the robot assisted laparoscopic stapler during ileoileal anastomosis compensate for shorter stapler length? – A randomized experimental porcine study
Published in Scandinavian Journal of Urology, 2021
Pernille Skjold Kingo, Gitte Wrist Lam, Jørgen Bjerggaard Jensen
Re-establishment of bowel continuity is imperative when constructing urinary diversion in patients given an ileal conduit or neobladder after radical cystectomy. The risks of complications and sequelae following radical cystectomy are considerable whether you use the open or robot assisted laparoscopic approach [1,2]. Although rare, anastomotic dehiscence is one of the most serious complications [3]. However, a less recognized but most likely a more common problem is relative stenosis of the bowel anastomosis if construction of the lumen is too small. This can lead to prolonged ileus in the postoperative phase and long-term bowel problems. The construction of intestinal anastomosis has evolved remarkably over the years, from hand sewn to stapled anastomoses and from open to robotic assisted laparoscopic (RAL) technique. Nowadays, the intestinal anastomosis is performed with minimal morbidity and mortality [4]. Construction of a stapled side-to-side anastomosis allows for a faster and better anastomosis according to leak rates and a faster learning curve compared to a hand sewn end-to-end anastomosis [5–8]. Thus, side-to-side anastomosis allows for the creation of a large diameter of anastomosis. However, proper handling of the bowel and staplers with a certain length are important in order to prevent strictures of the bowel [5].
Nutritional management of a polytrauma patient in an intensive care unit
Published in South African Journal of Clinical Nutrition, 2021
Postoperative ileus (POI) is the impaired peristalsis of the gastrointestinal tract, usually of the small bowel, after surgery.8,9 Although definitions of it vary, symptoms typically include nausea, vomiting, enteral feeding intolerance, abdominal distension and delayed time to flatus and stool.9 Prolonged ileus can have a notable impact on recovery and length of hospital stay.10 To manage POI, ESPEN recommends intravenous erythromycin or metoclopramide, or a combination of both.2 Gastrograffin is a radiological contrast substance used to analyse the GIT during CT studies.8 As well as detecting obstructions, its hyperosmotic nature may make it useful for treating relevant symptoms, although this use is limited and does not reduce the need for surgery.8 Another novel idea of treating POI is the use of chewing gum as a means of stimulating peristalsis.8,9,10 Studies have shown that chewing gum post-surgery may reduce time to first flatus, bowel sounds, bowel movement and length of hospital stay, but these have historically been small studies, limited to colorectal surgery and Caesarean sections.10