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Nutrition
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
The options for treatment of malnutrition are enteral nutrition (EN) and parental nutrition (PN). Evidence shows that the initiation of enteral nutrition within 24 to 48 hours of admission results in better outcomes when compared to no nutritional intake and surpasses the early initiation of PN. EN delivery is better performed through a small-bore tube into the duodenum or even jejunum, although it is acceptable to initiate in the stomach. The type of specialized nutrition should start with trophic feeds while awaiting a nutrition evaluation or full nutrition if the dietician has already made recommendations. If there is no relevant gastrointestinal pathology, then they can be increased rapidly while monitoring tolerance. It is not recommended to use gastric residual volume (GRV) measurement as part of routine care to monitor ICU patients receiving EN.
Case 45: Vomiting without Gastrointestinal Pathology
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
Lower gastrointestinal pathology will also need to be considered. Inflammatory bowel disease, particularly Crohn's disease, can present with vomiting, although abdominal discomfort is usually a feature. Pancreatobiliary disorders, such as cholecystitis or chronic pancreatitis, are less likely to be present in view of the patient's normal liver enzyme and amylase levels.
Diabetic Ketoacidosis and Hyperosmolar Coma
Published in Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu, Medical Management of Diabetes Mellitus, 2000
Signs of NKH are those of profound dehydration. Patients have dry mucous membranes, absent sweating, and poor skin turgor, as well as postural hypotension. Cardiac and respiratory examinations are typically normal in the absence of pneumonia. Tachypnea, hypotension, or fever may indicate a gram-negative infection. Gastroparesis is often present, owing to the hypertonic state; thus nausea and vomiting may mistakenly suggest an underlying gastrointestinal pathology precipitating the event.
Diagnostic and therapeutic challenge of unclassifiable enteropathies with increased intraepithelial CD103+ CD8+ T lymphocytes: a single center case series
Published in Scandinavian Journal of Gastroenterology, 2021
Christina Hartl, Jürgen Finke, Peter Hasselblatt, Wolfgang Kreisel, Annette Schmitt-Graeff
Chronic enteropathy associated with intraepithelial lymphocytosis (IEL) and villous atrophy (VA) of the duodenal mucosa and persistent diarrhea may result from many pathologies with celiac disease (CD) being the most prevalent underlying cause. In the absence of CD auto-antibodies and after exclusion of the clinically challenging diagnosis of seronegative CD, e.g., by exposure to gluten-free diet and HLA testing [1], a plethora of differential diagnoses have to be considered in patients with VA and IEL. Gastrointestinal pathology frequently occurs in primary immunodeficiency disorders (PID) such as the IPEX (immune dysregulation polyendocrinopathy enteropathy X-linked) or APECED syndromes (autoimmune polyendocrinopathy candidiasis ectodermal dystrophy) and CVID (common variable immunodeficiency) [2,3]. Potential causes also include medications such as olmesartan or immune checkpoint inhibitors, Crohn’s disease, infections (in particular, HIV infection, mycobacteriosis, giardiasis, Whipple’s disease), food intolerances or autoimmune enteropathy (AIE) [4,5]. The diagnostic work-up should therefore include blood tests for assessing malnutrition, ruling out seropositive or seronegative CD and testing for anti-enterocyte antibodies. In addition, microbiological examinations and endoscopies with duodenal biopsies are mandatory during diagnostic work-up to rule out infections, inflammatory bowel disease or lymphoproliferative disorders (LPD) [6,7].
Efficacy of preemptive endoscopic submucosal dissection and surgery for synchronous colorectal neoplasms
Published in Scandinavian Journal of Gastroenterology, 2020
Yohei Yabuuchi, Kenichiro Imai, Kinichi Hotta, Sayo Ito, Yoshihiro Kishida, Shoichi Manabe, Yusuke Yamaoka, Hitoshi Hino, Hiroyasu Kagawa, Akio Shiomi, Hiroyuki Ono
Resected specimens were spread out, pinned on a flat board, and fixed in 10% buffered formalin solution. Fixed materials were sectioned serially at 2 mm intervals, processed for paraffin embedding, and sliced into 3 μm thick sections for hematoxylin and eosin staining. To observe vascular invasion in detail, Elastica-Masson staining and immunostaining with D2-40 (Dako, Tokyo, Japan) were performed. Histological diagnoses were made by experts of gastrointestinal pathology. The resected lesion was considered at high risk for lymph node metastasis (non-curative) if any of the following was observed after endoscopic resection of pathological T1 CRC: (1) positive vertical margin; (2) depth of submucosal invasion ≥1000 μm; (3) poorly differentiated adenocarcinoma, signet-ring cell carcinoma, or mucinous carcinoma: (4) vascular invasion; or (5) grade 2/3 budding. Then, colorectal resection with lymph node dissection was recommended as an additional treatment in accordance with the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines [29]. The resection was considered curative when the resected lesion did not meet any of the findings described above, even if the lesion had an unknown lateral margin.
Better prognosis of gastric cancer patients with high levels of tumor infiltrating lymphocytes is counteracted by PD-1 expression
Published in OncoImmunology, 2020
M. Pötzsch, E. Berg, M. Hummel, U. Stein, M. von Winterfeld, K. Jöhrens, B. Rau, S. Daum, C. Treese
Tissue samples were collected from the archive of the Institute of Pathology, Charité- – Universitätsmedizin Berlin. Four hundred thirty-eight samples of formalin-fixed and paraffin-embedded (FFPE) tissue were available of chemotherapy-naïve patients undergoing surgery. Tissue samples were reevaluated for postoperative histological diagnosis, tumor stage, grading, and were morphologically classified using the Laurén and Ming classification by a pathologist with a special focus on gastrointestinal pathology (M.W.). Additional data concerning tumor size, depth of invasion, and tumor invasion of veins or lymphatic vessels were obtained from the Charité – Universitätsmedizin Berlin patient management software.