Nutrition and Gastrointestinal Disorders
David Heber, Zhaoping Li in Primary Care Nutrition, 2017
The idea of providing all nutrition through enteral supplements rather than foods is called exclusive enteral nutrition, and it is used for active disease. It was first used in 1973 in adults with Crohn’s disease resistant to other therapies (Voitk et al. 1973). Supplemental enteral nutrition may also be used to maintain a disease remission or to achieve adequate weight gain and growth (O’Sullivan and O’Morain 2006). Although research studies have confirmed its effectiveness in therapy, outcomes of this approach, when implemented in patients, are highly variable. Exclusive enteral nutrition is the initial therapy option in active Crohn’s disease. Parenteral nutrition is reserved to only being considered as an alternative method of nutrition for those who cannot tolerate enteral nutrition or during perioperative periods.
Nutritional Considerations
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Parenteral nutrition is rarely required in patients with head and neck cancer as most patients have an accessible and functioning gastrointestinal tract. National data suggests an incidence of <1% for patients with head and neck cancer.67 Parenteral nutrition may be used as a temporizing measure in patients with head and neck cancer who have obstructive tumours, making placement of an enteral feeding tube impossible. It may also be used for patients who have a chyle leak that has not responded to oral or enteral diet modification. Parenteral nutrition should be considered for individuals who are malnourished or at risk or malnutrition and have inadequate or unsafe oral/enteral nutritional intake and have a non-functional, inaccessible or leaking gastrointestinal tract.21 Parenteral nutrition can be stopped once adequate oral or enteral nutrition is tolerated and withdrawal should be planned and stepwise with a daily review of the patient’s progress.
Nutrition and fluid therapy
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Peripheral feeding is appropriate for short-term feeding of up to 2 weeks. Access can be achieved either by means of a dedicated catheter inserted into a peripheral vein and manoeuvred into the central venous system (peripherally inserted central venous catheter (PICC) line) or by using a conventional short cannula in the wrist veins. The former method has the advantage of minimising inconvenience to the patient and clinician. PICC lines have a mean duration of survival of 7 days. The disadvantage is that when thrombophlebitis occurs, the vein is irrevocably destroyed. In the alternative approach, intravenous nutrients are administered through a short cannula in wrist veins, infusing the patient’s nutritional requirements on a cyclical basis over 12 hours. The cannula is then removed and resited in the contralateral arm. Peripheral parenteral nutrition has the advantage that it avoids the complications associated with central venous administration, but suffers the disadvantage that it is limited by the development of thrombophlebitis (Figure19.7). Peripheral feeding is not indicated if patients already have an indwelling central venous line or in those in whom long-term feeding is anticipated.
Gastrointestinal manifestations of primary immune deficiencies in children
Published in International Reviews of Immunology, 2018
This is a rare X-linked syndrome due to a mutation in transcription factor forkhead box protein (FOXp3) affecting T-regulatory cells which leads to autoimmunity.42 IPEX is characterized by a triad of immune dysregulation, polyendocrinopathy (usually Type 1 diabetes mellitus) and enteropathy. This is an autoimmune disorder that affects males and presents in the first year of life.43 Children are affected by watery diarrhea, eczema, autoimmune hemolytic anemia, thrombocytopenia and neutropenia. Many patients require total parenteral nutrition. Patients usually die in childhood and the only cure is bone marrow transplantation. Histopathology of the small bowel in patients with IPEX syndrome has shown severe villous atrophy and mucosal erosion with lymphocytic infiltrates of the submucosa or lamina propria.44
A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years
Published in Clinical Toxicology, 2021
Yu-Jhou Chen, Chen-June Seak, Shih-Ching Kang, Tsung-Hsing Chen, Chien-Cheng Chen, Chip-Jin Ng, Chao-Wei Lee, Ming-Yao Su, Hsin-Chih Huang, Pin-Cheng Chen, Chun-Hsiang Ooyang, Sen-Yung Hsieh, Hao-Tsai Cheng
Proton pump inhibitors or H2 antagonists were prescribed to treat caustic injury. Patients received parenteral nutrition without oral intake until their clinical status was regarded as stable. In cases of suspected infection, blood cultures were obtained before the administration of antibiotics (gentamicin and first-generation cephalosporins). Once destabilization or respiratory difficulty was encountered, a patient was transferred to the ICU for critical care. Follow-up EGD was performed if indicated. After discharge, patients were followed up in the outpatient clinic for at least 6 months. Although the exact treatment strategies might have been altered individually according to different clinical conditions, the major principles for similar cases did not change significantly during the past 20 years at our center.
Ileostomy diarrhea: Pathophysiology and management
Published in Baylor University Medical Center Proceedings, 2020
Kyle M. Rowe, Lawrence R. Schiller
Regardless of the cause of high output, volume status, electrolyte disturbances, and subsequent sequelae must be addressed first. This will most often require intravenous fluids or oral rehydration solutions depending on the severity of the volume depletion. Dehydration prophylaxis immediately after ileostomy creation should be considered. In a randomized controlled trial in patients after diverting ileostomy, patients receiving 1 L daily of a prophylactic oral rehydration solution had zero dehydration-related readmissions compared to 24% in the control group.51 The prophylactic group also showed significant improvements in markers of renal function over 40 days of follow-up. Other studies have suggested that oral rehydration solution actually decreases the output; however, this was not seen in the randomized setting.52 Total parenteral nutrition is generally not required in these patients, as nutrient absorption should not be impaired.
Related Knowledge Centers
- Gastrointestinal Tract
- Glucose
- Amino Acid
- Lipid
- Intravenous Therapy
- Compounding
- Salt
- Vitamin
- Mineral
- Peripherally Inserted Central Catheter