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The effect of enteral nutritional support on skeletal muscle protein synthesis and whole-body protein turnover in fasted surgical patients.

Whole-body and muscle protein turnover have been studied in surgical patients, before abdominal surgery after an 18-h fast, using infusion of 1-[13C]leucine. Four patients received an unmodified hospital diet and four received extra nutritional support (1800 kcal, 70 g protein) by naso-jejunal tube for 7-10 d previously. In patients who received nutritional support there were significantly greater values of whole-body protein synthesis (+42 per cent, P less than 0.05) and breakdown (+45 per cent, P less than 0.01) and muscle protein synthesis (+36 per cent, P less than 0.05) than in those who received the unmodified hospital diet.

Aged↗

[Basis of early enteral feeding in the postoperative period].

Since the conception of a postoperative generalised inhibition of motility of stomach and gut has been disproved, there is a growing support for early enteral nutrition at present. The stomach should be evacuated from increased secretion by tube drainage. This should be combined with intraduodenal tube feeding. Immediately after surgery a sufficient absorption capacity of the small gut also makes early enteral nutrition possible.

Drainage↗

Value of nasogastric tube after colorectal surgery.

To evaluate the effect of tube decompression of the stomach after elective colorectal operations, 97 patients were randomly allocated to postoperative treatment with or without nasogastric tubes. Flatus passed earlier in the patient group without tubes. However, no significant differences were found between the two groups with respect to duration and severity of postoperative paralysis, as measured by occurrence and duration of nausea and vomiting, postoperative peroral fluid intake and time for defecation. The frequencies of postoperative complications were small in both groups and without any difference between groups. Tube decompression of the stomach does not relieve intestinal paralysis after elective colorectal operations. Tube decompression should be used only in patients with paralytic ileus.

Adolescent↗

Jejunal rupture caused by a Sengstaken-Blakemore tube.

In a patient with cirrhosis and bleeding esophageal varices who had previously undergone a partial gastric resection, the gastric balloon of a Sengstaken-Blakemore tube was inadvertently placed into the efferent jejunal limb of the gastrojejunostomy. Inflation of the balloon to the standard volume of 150 ml resulted in rupture of the jejunum. Precautions in the use of the Sengstaken-Blakemore tube that might prevent this complication are described.

Esophageal and Gastric Varices↗