GI functions?

GI functions?

1. Yes

   • Enteral Nutrition
     • Indications
       • Not receiving nutritionaldemands (for 5-7 days by mouth)
         • He can't
           • Neurological diseases Swallow problems Cerebrovascular patients Alzheimer Coma Any disease that increased nutritional requirements: Burns, Sepsis, Oncological Any disease the patient can't prevent their airway
         • He shouldn't
           • GI Surgery Inflammatory disease Pancreatitis
         • He doesn't want
           • Anorexia Bulimia
             • Access
               • Time?
                 • < 4 weeks
                   • Temporal access
                     • The gastric (Gold standard) or jejunal tube
                 • > 4 weeks
                   • Permanent aceess
                     • - Percutaneous endoscopic (GS) - Gastrostomy
                       • Contraindications -Morbid obesity - Peritonitis - Ascitis - Nephrological patients
                     • Surgical gastrostomy
                       • Indications: - When you perform other abdominal surgery - Contraindication for endoscopy
               • Risk of bronco aspiration?
                 • Yes
                   • Jejunal
                 • No
                   • Gastric
               • What formula?
                 • Polymeric Oligomeric Elemental Energy 1 kCal/mL
                 • Patients who need > proteins:
                   • Undernutrition, - catabolic patients - kidney with dialysis
                 • Patients who need < proteins
                   • Kidney without dialysis
     • Contraindications
       • Peritonitis, GI tract perforation, Incohesive vomit, GI obstruction GI ischemia GI bleeding Hemodynamic instability Pregnant lady Hypovolemic shock Enterocutaneous fistula
     • Benefits
       • -Preserve structure and physiology -Less complications -Maintain GAP junctions -Produce hormones and enzymes -Maintain micro biome -MALT and GALT (IgA) -Trophism

2. No

   • Parenteral nutrition
     • Indications
       • Doesn't pr he won't achieve nutritional goal by enteral route for more than 7 days 1. Short Bowel syndrome 2. Preoperative 10 days before surgery with undernutrition 3. Abdominal sepsis 4. Chron's disease
     • Contraindications
       • Functional GI trac Hemodynamic instability Less than 10 days (transferrin)
     • Access
       • < 4 weeks
         • Temporal access
           • Central
             • Subclavian PICC Yugular Femoral
           • Peripheral
             • Cephalic Basilic
       • > 4 weeks
         • Permanent access
           • All central catheters

3. Complications Enteral and parenteral nutrition

   • Mechanical
     • Enteral: perforation, laceration Pneumo/hemo/quilotorax Laceration of vein/artery/heart Obstruction Malposition
   • Infectious
     • Sepsis associated with catheter Diarrhea
   • GI complications
     • Paralytic ileus, atrophy translocation vomit diarrhea distention pain
   • Metabolic
     • Glicemia changes Electrolytic changes < Tiamine, Mg, K, P (Refeeding syndrome) > Osmolarity