Compilation Digestive

8/19/2019 Compilation Digestive

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Complications Associated with

Enteral Nutrition Using Tube

Jejunostomy after EsophagealReconstruction

Medrano, Crystal Joan D.

Abdelkader Boukerrouche



T e r m i n o l o

g i e s • Enteral nutrition – a way of providing food

through a tube placed in the nose, the stomach,or the small intestine

• Jejunostomy tube – a soft, plastic tube placedthrough the skin of the abdomen into themidsection of the small intestine

http://www.ncbi.nlm.nih.gov/projects/pmh/PMH_Authoring/media/Images/originals/CDR0000751388.jpg



I n t r o d u c t i o n • People who undergone esophageal

reconstruction are at high risk of developing

malnutrition.• The introduction of postoperative nutrition is

necessary for the anastomotic healing process:

enteral nutrition (EN).

• EN is not totally free from complications; these

complications may diminish the benefits.

• PURPOSE OF STUDY: examine the

complications associated with EN



M e t h o

d s

• 105 patients; between 1999 and 2014

• Age range:15-50 years

•

Jejunostomy site: 40 cm distal from thebeginning of the jejenum

• An early postoperative enteral nutrition wasstarted.

• A stepwise increase of the intake calories fromEN was scheduled and the number of caloriesadministered was increased gradually to achievethe target calorie requirement of the patient.

• Oral nutrition was introduced gradually; EN wasdiscontinued when oral nutrition with a normaldiet has been reestablished and adaptation withthe neo-esophagus was obtained.



R e

s u l t s a n d D i s c u s s i o n

• Placement and maintenance of jejunostomy catheter is notentirely safe.

• Modification of the strategy of placing the jejunostomy tubehas been advocated.

• The leakage of nutrients or intestinal fluid from the site of catheter entry and intestinal twisting at the point of fixture to

the abdominal wall can cause complications.



Conclusion

• The attachment of the jejunal wall to theperitoneum at the site of entry of thecatheter/tube is useful to prevent leakage andtwisting of the jejunum and to reduce the severityof the complications related to catheter/tube

jejunostomy feeding.



Gastric Ulcer: An Old Disease – A

New Cause

By: Silke Urban, Michael Manz, Andreas Zettl, Thomas Peters, Katrin Baumann and Markus von Flue

Reported by: Mearl Joy G. Tabuelog



Melena- black "tarry" feces that areassociated with upper

gastrointestinal bleeding





IgG4 related

disease

Storiform Fibrosis

Obliterating phlebitis



Possible Medication includes:

glucocorticoids, azathioprine andmycophenolate

Conclusion: gastric ulcer can be thefirst presentation of IgG4- related

disease



High-fiber diet during pregnancy may protect

offspring against asthma

Written by: Honor Whiteman

Presented by: Patrisha Kate Moises



General idea

• Women who consume a high-fiber diet duringpregnancy may reduce the risk of theiroffspring developing asthma.

HOW IS THIS SO?

• The study suggests a high-fiber diet alters a

mother's gut bacteria during pregnancy,producing anti-inflammatory substances thatsuppress asthma-related genes in offspring.



Methodology for mice

1. Team fed pregnant mice one of three diets during theirthird trimester: a high-fiber diet, a moderate-fiber diet ora low-fiber diet.

2. When the offspring of the mice were adults, they wereexposed to house dust mites - a trigger for asthma inhumans.

RESULTS

• Offspring of mice whose mothers were fed a high-fiber dietduring pregnancy did not develop asthma-like symptoms

• Offspring whose mothers were fed a low-fiber dietdeveloped asthma-like symptoms

• Pregnant mice fed a high-fiber diet experienced changes ingut bacteria



Methodology for humans

• Analysis of blood samples and diet data of 40 pregnantwomen

• Gathered data detailing the frequency of doctor's visitsdue to respiratory symptoms in their offspring during

the first year of life.RESULTS

• Women who consumed a high-fiber diet duringpregnancy also had anti-inflammatory metabolitespresent in their blood

• Offspring of these women were significantly less likelyto have visited the doctor two or more times as a resultof respiratory complaints in their first year of life.



DISCUSSION

• These metabolites circulated the bloodstreamand traveled through the uterus to the fetus,suppressing Foxp3 genes linked to asthmadevelopment.

• High fiber suppresses expression of certain genesin the mouse fetal lung linked to both humanasthma and mouse allergic airway disease

• Thus, diet acting on the gut microbiota

profoundly influences airway responses, and mayrepresent an approach to prevent asthma,including during pregnancy



Osteogenesis Imperfecta and

Constipation: A Case Report

Marwa Abu El Haija



Osteogenesis imperfecta (OI)

• Heritable heterogenous disorder

– Mutation in gene for collagen type 1

– have profound effect on extracellular matrix and

give rise to increased bone fragility and low bone

mass

– Type III is associated with GI problems e.g.

constipation



Case Report

• 18-year old girl

• chronic constipation was contributed to her

immobility and some degree of dehydration

• Significant findings

– absent bowel sounds,

– moderate tenderness on the RLQ

– mass measuring 13×6cm



• CT scan showed large fecal mass

– 10.2 cm in diameter and 13 cm in length

– fecal mass displaced the uterus and bladder

toward the left and compressed the Inferior Vena

Cava

• Biopsy also revealed Hirschsprung’s disease

– absence of ganglionic cells



Rapunzel Syndrome

A Case Report with Literature Review

By: Godara, R., Ar, B., Sandhya, Jaikaran, Tamaknand, Tripura



Rapunzel Syndrome

• Bezoar – “conglomeration of foreign material

in the intestinal tract”

• Trichobezoar – “accumulation of hair in the

gastric chamber”

• Rapunzel syndrome – “accumulation of hair

in the instestine”



Usually occur inchildren &

adolescents with:• Trichotillomania

• Trichophagia

• Gastric dysmotility disorder

Symptoms• Vomiting

• Abdominal pain

• Naussea

• malnutrition

Untreated patients:• Gastric outlet obstruction

• GI bleed

• Gastric necrosis

• Gastric perforation



Case report

• 18 year old female

• Dull aching epigastric

pain, non-bilious

vomiting, decreased

appetite, and weight

loss



• Gastric gastrotomy

• Enzymatic dissolution

•

Shock wave fragmentation• Antidepressants



The Mercedes-Benz Sign ofIschemic Colitis

Akira Hokama, Akane Fujita, Tetsuya Ohira, Masatoshi Kaida, Tetsu Kinjo and Jiro Fujita

Presented by: Christine Saac



Ischemic Colitis

• Most common form of ischemic injury ingastrointestinal tract

•

Hypoperfusion or vasospasm of splanchnicarteries

• Diagnosis: combination of clinical suspicion,

radiographic, endoscopic and histological findings

• Therapy: varies on severity



Physical Examination

•

Tenderness on left abdomen without bowelsounds

White blood cell count: 14,300/mm3

Stool culture: negative



Results



Compilation Digestive

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