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At least 685 records · Page 38Linked to original sources
PubMed1985

Management of bleeding angiodysplasia of the upper small intestine.

Five patients thought to have bleeding angiodysplasia in the distal duodenum and proximal jejunum were treated surgically after conservative measures failed to control hemorrhage. Aspiration through a long oral tube preoperatively and intraoperative endoscopy were most helpful in locating the site of bleeding.

Aged↗
PubMed1990

Intra-abdominal palpation of a nasogastric tube in the stomach does not assure appropriate placement.

Improperly placed nasogastric (NG) tubes have been associated with considerable morbidity. The only reliable indicator of correct NG tube placement appears to be the aspiration of gastric contents. We have reported a case of major morbidity from an improperly placed NG tube that perforated the cervical esophagus, dissected the mediastinum, and terminated in the omental bursa. No gastric aspirate was obtained by suctioning of the tube, but correct placement was presumed based upon the surgeon's direct intraoperative palpation of the tip of the tube. Failure to aspirate gastric contents should alert the practitioner to the possibility of improper NG tube placement.

Abdomen↗
PubMed2004

Diagnostic methods for the detection of anterograde aspiration in enterally fed patients.

PURPOSE OF REVIEW: The diagnosis of aspiration and its origin in patients on enteral tube feeding is challenging to the physician and provides an important means to prevent pneumonia. This review examines the most recent studies and developments in the field with an approach to the technical aspects of diagnostic methods. RECENT FINDINGS: The methods more commonly used to detect anterograde aspiration in clinical practice are fiberoptic endoscopic evaluation of swallowing and modified barium swallowing. Recent studies have shown that although these methods may provide the diagnosis of aspiration, their use for clinical monitoring is not appropriate. The studies comparing fiberoptic endoscopic evaluation of swallowing and modified barium swallowing have demonstrated that both tests present similar sensitivity, specificity and predictive values. SUMMARY: The different methods used to diagnose anterograde aspiration are appropriate for clinical practice, with a low complication rate and few contraindications. In most instances, the early diagnosis of aspiration and evaluation of other factors such as laryngeal sensibility, may predict the occurrence of aspiration pneumonia.

Barium↗
PubMed2003

Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia.

OBJECTIVE: Opioid analgesia impairs gastrointestinal motility. Enteral administration of naloxone theoretically allows selective blocking of intestinal opioid receptors caused by extensive presystemic metabolism. Therefore, we studied the effect of enteral naloxone on the amount of gastric tube reflux, the frequency of pneumonia, and the time until first defecation in mechanically ventilated patients with fentanyl analgesia. DESIGN: Prospective, randomized, double-blinded study. SETTING: University hospital intensive care unit. PATIENTS: Eighty-four mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases. INTERVENTIONS: Patients were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube during fentanyl administration. MEASUREMENTS AND MAIN RESULTS: Thirty-eight patients received naloxone and 43 placebo; three patients were excluded because of protocol violation. Median gastric tube reflux volume (54 vs. 129 mL, p =.03) and frequency of pneumonia (34% vs. 56%, p =.04) were significantly lower in the naloxone group. In both groups, time until first defecation, ventilation time, and length of intensive care unit stay did not differ. There was no difference in fentanyl requirements between the naloxone and the placebo group (7 vs. 6.5 microg/kg/hr, p =.15). CONCLUSIONS: Our results provide evidence that the administration of enteral opioid antagonists in ventilated patients with opioid analgesia might be a simple-and possibly preventive-treatment of increased gastric tube reflux and reduces frequency of pneumonia.

Administration, Oral↗
PubMed1991

Small bowel function after aortic surgery.

One cause of post-operative morbidity in the elective repair of abdominal aortic aneurysms is the development of a paralytic or 'adynamic' ileus. In a series of 20 consecutive patients undergoing such a procedure, the maintenance of small bowel motility and absorptive capacity in the immediate post-operative period was assessed using barium sulphate and xylose passed down a naso-duodenal tube sited at the time of surgery. This simple study demonstrated that small bowel function was preserved in all cases, and hence that patients could be fed enterally via naso-duodenal tube (in particular using very low residue formulae) rather than using costly parenteral regimens, should an ileus persist.

Aorta, Abdominal↗
PubMed2001

Energy nutrients modulate the splanchnic sequestration of dietary nitrogen in humans: a compartmental analysis.

We used a previously developed compartmental model to assess the postprandial distribution and metabolism of dietary nitrogen (N) in the splanchnic and peripheral areas after the ingestion of a single meal containing milk protein either alone (MP) or with additional sucrose (SMP) or fat (FMP). The addition of fat was predicted to enhance splanchnic dietary N anabolism only transiently, without significantly affecting the global kinetics of splanchnic retention and peripheral uptake. In contrast, the addition of sucrose, which induced hyperinsulinemia, was predicted to enhance dietary N retention and anabolism in the splanchnic bed, thus leading to reduced peripheral dietary amino acid availability and anabolism. The incorporation of dietary N into splanchnic proteins was thus predicted to reach 18, 24, and 35% of ingested N 8 h after MP, FMP, and SMP, respectively. Such a model provides insight into the dynamics of the system in the nonsteady postprandial state and constitutes a useful, explanatory tool to determine the region-specific utilization of dietary N under different nutritional conditions.

Amino Acids↗
PubMed1998

Effect of glucose supplementation on appetite and the pyloric motor response to intraduodenal glucose and lipid.

The effects of different macronutrients on appetite and pyloric motility and the impact of short-term dietary glucose supplementation on these responses were evaluated. Ten males (aged 19-38 yr) received isocaloric (2.9 kcal/min) intraduodenal infusions of glucose and lipid while antropyloroduodenal motility and appetite were assessed by manometry and visual analog scales, respectively. Effects of each intraduodenal nutrient on appetite and motility were evaluated before and after 7 days of dietary supplementation with glucose (400 g daily). Initially, both nutrients caused a similar rise in pyloric tone, but intraduodenal lipid was a more potent stimulus of phasic pyloric motility (P = 0.05) and suppressed appetite more (P = 0.013) than intraduodenal glucose. After dietary glucose supplementation, the increase in pyloric tone during intraduodenal glucose was attenuated. Although intraduodenal lipid remained a more potent stimulant of phasic pyloric motility (P = 0.016), it no longer decreased appetite. We conclude that in healthy young males 1) intraduodenal infusion of lipid is a more potent stimulus of phasic pyloric motility and suppresses appetite more than intraduodenal glucose and 2) dietary glucose supplementation alters both the appetite suppressant effect of intraduodenal lipid and the pyloric motor response to intraduodenal glucose infusion.

Adult↗