Appendix Appendectomy Operation by Dr. Alexandros Iagmour

My Appendix Appendectomy Operation by Dr. Alexandros Iagmour

https://www.youtube.com/watch?v=rsG6xvVDI9U

Read More

Nutritional diseases , nutrition 1 , last part

Nutritional therapy

•Provide a life sustained therapy for the patient who can not take adequate food by mouth who consequently at risk for malnutrition and its complication

Benefits of Nutritional Support
•Preservation of nutritional status
•Prevention of complications of protein malnutrition
• Post-operative complications

Nutritional therapy given when
•1. improve the quality of life.
•2. improve the ability to recover from the disease.
Don’t forget it depend : disease outcome
severity of the malnutrition
any additional stress

Who Requires Nutritional Support?
•Patients already with malnutrition – surgery / trauma/sepsis
•Patients at risk of malnutrition

Patients at Risk of Malnutrition
Cannot eat for >9 days
Vomiting : acute pancreatitis ,hperemesis gravidarum GIT obstruction: malignancy neurological : coma , swallowing dis. Abdominal pain : A. pancreatitis
Can not absorb: intestinal fistula ,short bowel syndrome
Should not eat: bowel rest in

•Others
nutritional support in patient with malignancy
nutritional support in malnourished patient before surgery

Type of the nutritional rehabilitation
•Normal diet mild malnutrition and treatable disease
•Supplement high energy and protein content used if normal diet cant give sufficient nutrition
•Specific Nutritional support
Enteral feeding

Types of Nutritional Support
Enteral Nutrition
Parenteral Nutrition

Enteral Feeding Is Best
•More physiologic
•Less complications
•Gut mucosa preserved
•No bacterial infection
•Cheaper

Enteral Feeding Is Indicated
•When nutritional support is needed
•Functioning gut present
•No contra-indications
–no ileus, no recent anastomosis, no fistula

Types of Feeding Tubes
•Naso-gastric tubes
•Naso-duodenal tubes
•Naso-jejunal tubes
Tubes inserted down the upper GIT,
following normal anatomy

Types of Feeding Tubes
•Gastrostomy tubes
–Percutaneous Endoscopic Gastrostomy (PEG)
–Open Gastrostomy
•Jejunostomy tubes Tubes that require an invasive procedure for insertion(feeding for long time

What Can We Give in Tube Feeding?
Blenderised feeds
Commercially prepared feeds

Complications of Enteral Feeding
12% overall complication rate
•Gastrointestinal complications
•Mechanical complications
•Metabolic complications
•Infectious complications

Complications of Enteral Feeding
Gastrointestinal
•Distension
•Nausea and vomiting
•Diarrhoea
•Constipation

Complications of Enteral Feeding
Infectious
•Aspiration pneumonia
•Bacterial contamination

Complications of Enteral Feeding
Mechanical
•Malposition of feeding tube
•Sinusitis
•Ulcerations / erosions of nasal and esoph
•Blockage of tubes

Parenteral Nutrition

Parenteral Nutrition
Allows greater caloric intake
BUT
•Is more expensive
•Has more complications
•Needs more technical expertise

Who Will Benefit From Parenteral Nutrition?
Patients with/who
–Abnormal gut function
–Cannot consume adequate amounts of nutrients by enteral feeding
–Are anticipated to not be able to eat orally by 5 days
–Prognosis warrants aggressive nutritional support

Two Main Forms of Parenteral Nutrition
•Peripheral Parenteral Nutrition
•Central (Total) Parenteral Nutrition

Peripheral Parenteral Nutrition
Given through peripheral vein
•Short term use
•Mildly stressed patients
•Low caloric requirements
•Needs large amounts of fluid
•Contraindications to central TPN

What to Do Before Starting TPN
•Nutritional Assessment
•Venous access evaluation
•Baseline weight
•Baseline lab investigations

Baseline Lab Investigations
•Daily : urea , electrolytes, glucose
•Twice weekly : LFT, calcium, phosphate, magnesium
•Weekly: CBC, zinc, triglycerides
•Monthly: copper, selenium, manganese

Formula of the TPN
•Dextrose 10% ,20% glucose
•Intralipid 10%, 20% fatty acid
•Vamine ( amino acid) 8%, 14%
•Vitamins
•Minerals
•Trace elements

Complications Related to TPN
•Mechanical Complications
•Metabolic Complications
•Infectious Complications

Mechanical Complications Related to vascular access technique
•pneumothorax
•air embolism
•arterial injury
•bleeding
•brachial plexus injury
•thoracic duct injury

Mechanical Complications
Venous thrombosis
Catheter occlusion Related to catheter in situ

Metabolic Complications
Abnormalities related to excessive or inadequate administration
–hyper / hypoglycemia
–Fluid and electrolyte: Refeeding syndrome
hypomagnesemia, hypokalemia, hypophosph
Congestive heart failure
–acid-base disorders

Hepatic complications
•Biochemical abnormalities
•Cholestatic jaundice
•Hepatic steatosis
•Gall stones
•Acalculous cholecystitis
  Infectious Complications
◦Insertion site contamination
◦improper insertion technique
◦use of catheter for non-feeding purposes
◦contaminated TPN solution
◦contaminated tubing
•Secondary contamination
–septicaemia   

Read More