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PubMed1999

[Enteral nutrition: ways of access and formulas].

Enteral nutrition is a very adequate method to feed those patients who can not receive food by oral means, to be used only when their gastrointestinal functions are preserved and carry out a proper assimilation of nutrients. Starting from these facts, this article analyzes the various access ways which can be used in enteral nutrition, and the most commonly used enteral nutrition formulas, noting their possible classifications. The nutritional modules and the material necessary to employ this form of feeding, as well as the administrative guidelines, are also presented in this article.

Algorithms↗
PubMed1975

Multiple vascular and gastric cannulation of swine for studies of gastrointestinal, liver, and peripheral tissue metabolism.

The implantation of multiple chronic indwelling vascular cannulas and of a gastric cannula into swine was described. Technics for housing, care, and handling of the animals pre- and post-surgically were established to reduce the incidence of infection and to allow collection of urine and feces in metabolic studies. This regimen has been used in 20 gilts to study absorption, tissue distribution, metabolism, and excretion of nutrients. On the average, the cannulas remained patent for 4 wk.

Anesthesia, Inhalation↗
PubMed1985

Effects of intrauterine nutritional supplementation on fetal growth retardation.

The effects of fetal nutritional supplementation on experimentally induced growth retardation were investigated in third-trimester sheep. The control group, C, was fed ad libitum (n = 8). Group R received a protein- and calorie-restricted diet over the last 3 weeks of gestation (n = 8). Group RS was given the same restricted diet as group R, and fetal, intragastric supplements of amino acids and glucose (n = 7). Over the experimental period, maternal weight increased 4.1 +/- 0.6 kg in C but was stable in R and RS (p less than 0.01). R and RS ewes and fetuses showed biochemical evidence of malnutrition but the changes were less severe in the RS group (p less than 0.05). Nutrient levels did not change in group C ewes and fetuses. At delivery, R lambs were smaller in weight and length than RS or C (p less than 0.05); gestational ages were the same. Weights were: R, 2,702 +/- 182 g; RS, 3,235 +/- 121 g; and C, 3,290 +/- 297 g. R also had lower fetal to maternal weight ratios and higher brain to body weight ratios than RS or C (p less than or equal to 0.05). Placental size was reduced 28% in R compared to C (p less than 0.05) and was intermediate in RS. The disparity in fetal size was explained by differences in nutrient acquisition between groups. Over the experimental period, caloric intake rose 24% in C fetuses; near delivery, they had the highest umbilical uptakes of carbohydrate and alpha-amino nitrogen. After maternal diet was limited, R and RS fetuses had dramatic decreases in umbilical uptake of alpha-amino nitrogen and static umbilical uptakes of carbohydrate. Caloric intake fell 42% in R. RS fetuses, however, were receiving sufficient gastric supplementation so that umbilical + gastrointestinal carbohydrate uptake equalled that of controls, and entry of alpha-amino nitrogen and calories was intermediate, between those of R and C. Fetal oxygen consumption reflected the differences in nutrient uptake, being greatest in C, lowest in R and intermediate in RS. Fetal supplementation lessened the drain on maternal nutrients and promoted more normal fetal growth and metabolism.

Amino Acids↗
PubMed1990

Enteral access device selection.

Enteral tube feedings have once again emerged as the first choice for nutritional support of the patient on the basis of safety, convenience, and economy. In order to provide adequate nutrition, an appropriate route of administration must be identified. Tube selection will depend on an accurate assessment of the patient, including the duration of therapy, history of abdominal procedures, competency of gag reflex, level of debilitation, gastrointestinal function, and discharge plan. Since placement of these tubes may involve several different physicians, a coordinator is necessary. The clinical specialist in nutrition support may be the appropriate health professional to coordinate this care. With an emphasis on shorter hospital stays, more patients may go home with enteral feeding regimens. The clinical specialist will need to be aware of these changes and become more involved in the initial enteral access device decision to insure appropriate selection.

Enteral Nutrition↗
PubMed1975

The double-contrast upper gastrointestinal examination in the Japanese style.

An experience with over 2,000 Japanese-style double-contrast upper gastrointestinal examinations is presented. Results indicate that, in combination with the conventional single-contrast films, the double-contrast examination of the stomach greatly increased the yield and accuracy of the radiographic procedure. The double-contrast study appears to have particular applicability in detecting lesions which do not greatly elevate or depress the surface of the stomach, such as early carcinomas, shallow ulcers, ulcer scars, small polyps and other similar mucosal abnormalities.

Age Factors↗
PubMed1992

[The indications and methods for decompression of the gastrointestinal tract in injuries to the abdominal cavity organs].

The article analyses the treatment of 122 patients with injuries of organs in abdominal cavity. One of the most important elements in intra- and postoperative treatment for paresis or paralysis of intestines was an abdominal decompression. Its basic methods were the following: nasoenteral drainage, gastroenterostomy by Iu. M. Dederer's method (31), enterostomy by I. D. Zhitniuk (25), and cecostomy (2). The application of decompression made it possible to treat the patients with severe peritonitis caused by gunshot injuries.

Abdominal Injuries↗
PubMed1982

Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases.

Ten cases of antibiotic-associated colitis (AAC) were identified at a hospital in Washington, D.C., from March 17 to May 9, 1979. No geographic clustering of cases was found, nor was an association with increased use of antibiotics demonstrated. Exposure to aminoglycosides, cephalosporins, and clindamycin was associated with AAC, as was a history of enemas in the seven days before the onset of illness (P=0.045). This association was strengthened when gastrointestinal procedures-defined as (1) three or more enemas per week, (2) the insertion of a nasogastric tube for two or more days, or (3) gastrointestinal surgery-were performed within seven days of the onset of illness (P=0.007). Clostridium difficile was not isolated from the hospital environments, nursing personnel, or family members of the patients. C. difficile was isolated from stool specimens of five (36%) of 14 patients who served as controls.

Adult↗
PubMed1995

Access routes for enteral nutrition.

Comprehensive management of patients includes a thorough evaluation of nutritional requirements. The risks and the benefits of enteral and parenteral supplementations have been heavily investigated. Recent literature supports use of the gastrointestinal tract, when functioning, as the preferred route for supplemental nutrition. There are multiple access routes available to clinicians to provide enteral nutrition, including feeding tubes, which can be placed transnasally, percutaneously, or surgically. These various techniques have individual indications, contraindications, and complications associated with the procedures. They also have varying levels of invasiveness and overall durability. We discuss the different access routes available for enteral feeding, as well as the process for selecting the most appropriate route.

Enteral Nutrition↗
PubMed1987

Intramural duodenal hematoma: an unusual complication of endoscopic small bowel biopsy.

We report a case of intestinal obstruction secondary to intramural duodenal hematoma after endoscopic small bowel biopsy. Review of the literature indicates that intramural duodenal hematoma occurs mainly in infants and children after trauma to the abdomen. The diagnosis can be made by upper gastrointestinal series and confirmed by computerized axial tomography of the abdomen. Conservative management in the form of nasogastric suction and total parenteral nutrition resulted in amelioration of obstructive symptoms within 10 days. Physicians should be alerted to the possibility of developing intramural duodenal hematoma after small bowel biopsy. This is the first report of such an unusual complication after endoscopic small bowel biopsy in children.

Biopsy↗
PubMed1988

Impact of unusual gastrointestinal problems on the treatment of tricyclic antidepressant overdose.

We report the cases of two patients with tricyclic antidepressant overdose in which the use of charcoal was hampered by gastrointestinal abnormalities. In the first patient, a previous gastric bypass procedure impeded the placement of an orogastric tube and subsequent charcoal administration, while potentially facilitating rapid absorption of the drug--factors that may have contributed to her death. In the second patient, severe esophageal spasm delayed therapy until IV nitroglycerin relieved the functional obstruction. Both circumstances are previously unreported complications associated with tricyclic antidepressant overdose. Potentially corrective measures are proposed.

Adult↗
PubMed1977

The importance of nutritional support for the geriatric surgical patient.

An appropriately designed program of nutritional support will allow the geriatric patient to undergo necessary surgical therapy with fewer risks and improved results. The selection of the route of administration and the specific agent(s) will depend on the functional status of the gastrointestinal tract as well as the patient's protein and calorie requirements. Table 6 summarizes our recommendations in the delection process. Our obvious preference is the gastrointestinal tract route if possible. When this optimum method of nutritional management is not available, sequential or concurrent supplemented feedings or intravenous hyperalimentation may be required to achieve adequate protein calorie intake. Regardless of the route chosen, careful monitoring of the geriatric patient's response to nutritional therapy is required. Only through careful planning and execution of nutritional therapy can optimum results be achieved in this group of patients.

Age Factors↗
PubMed2000

Retrograde jejunogastric intussusception.

Retrograde gastrointestinal intussusception is a rare entity, most commonly reported after gastric resection and gastrojejunostomy. Its occurrence in the absence of previous gastric resection is extremely unusual, with only four cases reported. All cases were associated with previously placed gastrostomy tubes and implicated these as the inciting factor. We present a fifth case and review the literature. The mechanism of this phenomenon is described and recommendations to prevent this potentially fatal complication are made.

Aged↗
PubMed1999

Nutritional management of chronic intestinal pseudo-obstruction.

Chronic intestinal pseudo-obstruction (CIP) is a gastrointestinal motility disturbance characterized by recurrent episodes of postprandial nausea and bloating in the absence of mechanical obstruction of the small bowel or colon. Weight loss and severe malnutrition are often seen in advanced stages of the disorder. This article discusses the nutritional management of patients with CIP, focusing on general dietary as well as enternal and parenternal nutritional support. Enteral access methods and various enteral formulas used in CIP are also discussed.

Chronic Disease↗
PubMedDate not supplied

Nutritional concepts in the treatment of head and neck malignancies.

Cancer cachexia should no longer be a contraindication to adequate antineoplastic treatment. Current methods of nutritional assessment allow one to identify malnutrition and to follow the nutritional status of the patient throughout the cancer-management program. Enteral nutritional repletion and maintenance remain the ideal course of action, but the gastrointestinal tract is not always readily available or advisable for use; in such circumstances, intravenous hyperalimentation (IVH) may be indicated. The properly nourished patient better tolerates cancer therapy, experiences fewer complications of malnutrition (e.g., sepsis and poor wound healing), and has a better-functioning immune system than does his malnourished counterpart. This article reviews methods of nutritional assessment, delineates indications and techniques for nutritional repletion, and summarizes the results obtained.

Dietary Proteins↗
PubMedDate not supplied

Enteral feeding: an overview of indications and techniques.

Most patients requiring nutritional support can be successfully managed using enteral feeding, i.e. the provision of nutritional support via the gastrointestinal tract. Various routes of access are available and patients should be assessed on an individual basis by the multidisciplinary team to select the most appropriate method and decide on a suitable regimen. Careful management and regular monitoring of enteral feeding are required in order to ensure safe and cost-effective nutritional support; the use of standard protocols and guidelines is recommended. With appropriate training, monitoring and support, enteral feeding is best provided in the community for many patients, and the use of home enteral feeding is rapidly increasing.

Enteral Nutrition↗
PubMed1986

A multipurpose overtube for diagnostic and therapeutic flexible fiberoptic endoscopy.

A newly devised overtube for diagnostic and interventional endoscopy has been used in 140 cases. In 60 cases of acute gastrointestinal bleeding, adequate gastric lavage was completed in 14.1 +/- 1.3 min, using an average of 7.5 +/- 0.69 liters; the volume of fluid recovered was 103.9 +/- 0.58% of the volume infused. This tube also allows simultaneous gastric lavage and esophageal or gastric tamponade, enabling therapeutic intervention with sclerotherapy or bipolar coagulation in the patient with acute massive bleeding. This device can be employed for the removal of bezoars, foreign bodies, and multiple polyps.

Adolescent↗
PubMedDate not supplied

Aversive behavior during intraoral intake in male rats.

We investigated if the taste of a sucrose solution becomes progressively more aversive during intraoral infusion and if this contributes to the termination of the intake in male rats. The display of aversive behavior, such as gapes and chin rubs, but not headshakes, forelimb flails or orofacial grooming, varied with the concentration of an intraorally infused solution of quinine hydrochloride (QHCl) and increased by the time the rat rejected an intraorally infused 2 M solution of sucrose. Activation of gapes and chin rubs by brief intraoral infusion of QHCl advanced the rejection of the sucrose solution if given late during intraoral infusion, but blockade of gaping by anaesthesization of the oral cavity with Xylocain did not prolong the intake of the sucrose solution. Headshakes and forelimb flails could be elicited by stimulating the head and limbs with sucrose, and gapes and chin rubs were activated by infusion of a 2 M solution of sucrose into the stomach or duodenum but not by infusion of glucose into the jugular or hepatic portal vein. Preventing filling of the gastrointestinal tract during intraoral infusion of sucrose (sham feeding) eliminated the display of gapes and chin rubs. It is suggested that an increase in the aversiveness of the taste of a sucrose solution contributes to the rejection of that solution during intraoral infusion. However, rats can reject a sucrose solution in the absence of any behavioral sign of aversion and none of the so-called "taste-related" aversive behaviors is exclusively dependent upon stimulation of the taste receptors in the oral cavity.

Animals↗
PubMedDate not supplied

[Accuracy of acidity changes in the gastrointestinal tract as determined by pH-tubes with the internal and external comparison electrodes].

It was for the first time that the presence of diffusive potentials on the borders between segments of the gastrointestinal tract (GIT) with differing compositions and pH values were detected in the practice of pH-metry. The diffusive potentials were found to be a cause for a considerably worsening accuracy of pH measurements by the second measuring electrode of the two-electrode pH-tube with the internal comparison electrode. On the contrary, when pH-tube with the external cutaneous comparison electrode is in use, the measuring accuracy does not deteriorate virtually for all electrodes in the latter case.

Electrodes↗