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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An elemental diet was used to prepare 11 severely debilitated malnourished patients for operation. Indications included: 1) as a substitute for parenteral hyperalimentation when catheter sepsis occurred with the latter; 2) high small fistulae; 3) short bowel syndrome; 4) radiation enteritis; and 5) partial obstruction of the gastrointestinal tract. All patients were converted to a positive nitrogen balance as evidenced by a substantial gain in weight and in serum albumin levels. All tolerated corrective operations without difficulty and their wounds healed per primum.
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PMID:Use of elemental diets to correct catabolic states prior to surgery. 420 17

This article has dealt briefly with intravenous nutrition in intestinal disorders. The indications for its use and techniques of nutritional assessment have been stressed. The use of intravenous hyperalimentation in a few of the more common diseases of the small bowel and colon has been discussed. Every patient with disease of the small or large intestine has some degree of dysfunction in the gastrointestinal tract. In many instances, this functional impairment interferes with normal ingestion or absorption of nutrients and predisposes the patient to malnutrition. The presence of malnutrition increases the morbidity and mortality of surgery and can be reversed by using intravenous hyperalimentation. Those patients with extreme short bowel syndrome secondary to intestinal disease or its parenteral nutrition at home. We stress the importance of a team approach to hyperalimentation. The evolution of a team of nutritional experts will improve the care of the patient and the education of the patient and physician and make nutritional support more readily available to those medical and surgical patients in need.
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PMID:The role of intravenous hyperalimentation in intestinal disease. 640 22

During a 9-year period, 204 infants younger than 12 months of age had 294 Broviac central venous hyperalimentation catheters inserted. Fifty-nine adult-size and 235 infant-size Broviac catheters were used. Catheter insertion was via the saphenous vein (267), external jugular (7), internal jugular (16), cephalic (2), and transthoracic right atrial veins (2). General anesthesia was used for all internal jugular, but for only 11 saphenous catheters. Catheter function ranged from 6 to 925 days (mean, 112 days). Forty-four infants had malabsorption syndromes, 36 had short bowel syndrome, 38 had intractable diarrhea, and 86 required nutritional support for a variety of other conditions. Fifteen of the 204 infants developed inferior (10) or superior vena caval thrombosis (2), or both (3). Thrombosis occurred in 13 of the 267 infants with saphenous catheters (4.9%), and five of the 25 with jugular or cephalic venous catheters (20.0%). Obstruction to normal catheter infusion was the first sign of caval occlusion. Transient mild leg edema (4) and prominent venous pattern over the legs (3) were present with inferior vena caval (IVC) occlusion, but no patient had renal vein obstruction or died as a direct result of this condition. Each of the two patients with superior vena caval (SVC) occlusion experienced mild to moderate edema and venous suffusion of the head and upper extremities, and one developed a pleural effusion. Each of the three infants with combined superior and inferior vena caval thrombosis died from pulmonary insufficiency within six months after SVC occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complications of superior versus inferior vena cava occlusion in infants receiving central total parenteral nutrition. 644 Sep 68

During a five year period at UCLA Hospital, 118 Silastic, Broviac, central venous hyperalimentation catheters were inserted into 94 infants who were less than one year of age. The indications for total parenteral nutrition were malabsorption syndrome in 26, short bowel syndrome in 24, diarrhea in 15, nutritional support following operation in 11 and miscellaneous in 18. One hundren and two catheters were placed into the vena cava by way of the saphenous vein at the groin, and 16 were inserted through the external or internal jugular veins. The duration of catheter use varied from six to 925 days, a mean of 104 days. In six infants, obstruction of the vena cava developed, five in the inferior vena cava and one in the superior vena cava. Swelling of the extremity was minimal, and the thrombosis was insidious in each patient. None of the patients had pulmonary emboli. Although two of the six patients eventually died, in neither was thrombosis of the cava believed to be related. Thrombosis of the vena cava is a frequent sequela of long term central venous hyperalimentation in infants, but it is rarely fatal and produces remarkably few serious complications.
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PMID:Occlusion of the vena cava in infants receiving central venous hyperalimentation. 680 43

Intestinal fistulae are an uncommon but serious complication of pelvic exenteration. To characterize factors leading to fistula formation and to define optimal management of this complication, we reviewed 533 cases of patients who underwent pelvic exenteration at the University of Texas M. D. Anderson Cancer Center between 1957 and 1990. Forty-two of those patients developed an intestinal fistula following total (n = 29), anterior (n = 12), or posterior (n = 1) exenteration which was not tumor related. Prior to routine pelvic floor reconstruction, the fistula rate was 16%. With the advent of omental pedicle grafts and gracilis flaps, the rate decreased to 4.5%. The fistulae described included those from the small bowel to the pelvic cavity (n = 15) or the neovagina (n = 8), and from the large bowel to the neovagina (n = 8). Complex fistulae were noted in 11 patients. Early fistulae, those that developed during initial hospitalization, occurred in 25 patients and were mainly related to infectious complications. Twenty-three patients underwent attempted surgical repair of fistulae. Eleven died during their hospitalization of sepsis, recurrent wound complications, or fistula. Late fistulae, those that developed after discharge, occurred in 17 patients and were mainly related to delayed healing. Early and late fistulae did not differ in location. Only two patients with late fistula formation died from complications of therapy. Significant long-term morbidity, however, included short bowel syndrome. Based on our review, we conclude the following: (1) Pelvic floor reconstruction, careful attention to surgical technique and aggressive treatment of infections reduces the risk of early fistula formation; (2) in cases associated with significant infection, treatment should be surgical; and (3) in stable patients, conservative management with hyperalimentation and bowel should be considered.
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PMID:Intestinal fistulae formation following pelvic exenteration: a review of the University of Texas M. D. Anderson Cancer Center experience, 1957-1990. 789 87

The ultimate prognosis for patients with short bowel syndrome (SBS) has become progressively more favorable over the past decade. Advances in long-term total parenteral nutrition (TPN) have allowed this group of patients to meet nutritional needs while the process of intestinal adaptation occurs. Unfortunately, a subgroup of patients with SBS have hepatic failure (HF), most often secondary to TPN-induced cholestasis. Combined small bowel and liver transplantation (LT) offers a sound anatomic solution for cases of HF with SGS, but it remains experimental at this time. We propose that an isolated LT is a viable alternative mode of therapy for the patient with HF and SBS. The following characteristics were reviewed for five patients with SBS and HF who underwent LT: age at transplantation, weight, liver function, survival, intestinal length, volume of feeding before surgery, and current feeding tolerance and liver function. Four boys and one girl, aged 5.5 to 15 months (average, 11.9), had LT. The total bilirubin level at the time of transplantation was 14.4 to 37 mg/dL (average, 24.7). The patients weighed between 3.8 and 12 kg (average, 8.0), and feeding tolerance ranged from no enteric to complete enteric feeding (average, < 33% of calories by enteric feeding). Bowel loss was attributed to necrotizing enterocolitis in two cases, volvulus in two, and birth hypoxia in one. Bowel length ranged from 60 to 120 cm (average, 88.6). Four children (80%) survived LT, and the average follow-up period was 9.3 months. Three (75%) are home; one is on combined hyperalimentation and enteral feeding, and two are on full enteric feeding. One remains in a chronic care facility, on combined enteral and intravenous feeding. The average daily enteral feeding now comprises more than 70% of caloric requirements. The total bilirubin level is .6 to .8 mg/dL (average, .71). Isolated LT for HF in the patient with SBS effectively restores liver function, allowing time for further intestinal adaptation.
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PMID:Isolated liver transplantation for liver failure in patients with short bowel syndrome. 807 12

Short-bowel syndrome is a state of severe malabsorption secondary to extensive bowel resection. The most common reasons for extensive bowel resection are Crohn's disease and mesenteric infarction. The pathophysiological consequences depend on extent and site of resection, integrity and adaptation of the remaining bowel, and secondary effects on other organs. Most extensively bowel resected patients can be adequately nourished by mouth, especially since they develop compensatory hyperphagia. For patients with colon in function a high-carbohydrate low-fat diet is beneficial compared to a diet with a normal fat content, because it results in decreased diarrhoea, decreased faecal mineral losses, and increased energy assimilation. The relative amount of dietary fat does not influence stool mass or energy assimilation in jejunostomy patients. Patients with jejunostomy have a high faecal output of water, sodium, and divalent cations, and they often need permanent parenteral supply of saline as well as calcium and magnesium if their small intestinal remnant is < 200 cm and parenteral nutritional support if they retain < 100 cm small bowel. In contrast, 50 cm of the jejunum often suffices for adequate oral nutrition if most of the colon is preserved. The majority of patients needing long-term intravenous supply are trained to administer parenteral nutrition at home (HPN). Most patients on HPN obtain a good or fair quality of life with hospital readmissions corresponding to an average of 10% of the HPN duration and an overall HPN related mortality of about 4%.
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PMID:Nutrition in short-bowel syndrome. 872 85

Cloacal exstrophy is a rare condition in which there is a complex set of congenital anomalies that affect multiple-organ systems, including the gastrointestinal tract. Twenty-six patients with cloacal exstrophy have been treated at the authors' institution during the last 20 years. Gastrointestinal features usually included omphalocele, exstrophy of an everted cecal plate, a short blind-ending distal colon, imperforate anus, and, occasionally, a shortened small bowel. Additional gastrointestinal anomalies included four cases of colonic duplication, one duodenal web, and one malrotation. The average time until the initiation of enteral feeding after initial surgery was 15.6 days, and the time until discontinuation of total parenteral nutrition (TPN) was 36 days. One patient with short bowel syndrome died of TPN-associated liver failure. Five other patients exhibited short bowel physiology, but ultimately each was weaned from supplemental intravenous hyperalimentation. Four patients have undergone posterior sagittal anorectoplasty, and one has had perineal anoplasty. Of these patients, two are continent and one is free of soilage on a bowel management program. In the authors' experience with management of the gastrointestinal tract and nutrition in patients born with cloacal exstrophy, many patients initially exhibited short bowel physiology, although most eventually adapted. However, very few patients have been able to achieve bowel control.
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PMID:Management of the gastrointestinal tract and nutrition in patients with cloacal exstrophy. 878 99

Cystic fibrosis (CF) is an inherited disorder that presents as a multisystem disease with meconium ileus being the presenting symptom in 20% of patients. Approximately half of these patients present with complicated meconium ileus mandating early surgical intervention, potentially resulting in short gut syndrome. Although liver transplantation in children with CF has been described, this is the first report of a combined liver and small bowel transplant in a recipient with CF. A 7-month-old boy with CF presented with short bowel syndrome following extensive small bowel resection for meconium ileus and progressive cholestatic liver failure from intravenous hyperalimentation. He underwent combined liver and small intestinal transplant. He was discharged home three weeks post-transplant on enteral feeds with supplemental intravenous fluid. He has had routine protocol small bowel allograft biopsies with no documented rejection episodes. He has been treated for minor respiratory infections without major sequelae. Improvements in pulmonary therapy have impacted on the survival in the CF population to the point where the need for multiorgan transplantation will be increased in the future. Extrapolating from the excellent experience of liver transplantation in children with CF, early liver and small intestinal multivisceral transplantation, if indicated, can be performed safely in children with CF.
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PMID:Liver and intestinal transplantation in a child with cystic fibrosis: a case report. 1275 51

The short bowel syndrome (SBS) is a complex entity due to anatomical or functional loss of part of the small bowel originating a clinical picture with severe metabolic and nutritional impairments due to reduction of the effective absorptive surface area of the gut. SBS is one of the causes of a larger entity known as "intestinal failu-Currently, mesenteric vascular accidents are the main cause in adults, followed by inflammatory bowel disease, and radiation enteritis, whereas in children, the main causes are congenital and perinatal diseases. The clinical picture associated with SBS varies according to the length and location of affected small bowel, the presence of underlying disease, the presence or absence of the large bowel and ileocecal valve, and the nature of the underlying disease. Intestinal adaptation is the process by which, throughout 1-2 years, intestinal absorption is reestablished to the situation prior to intestinal resection, and is a key factor determining whether a patient with SBS will progress to intestinal failure and depend on DPN. Intestinal adaptation may take place if the patient does oral intake higher than the usual one (hyperphagia); besides, the bowel may also adapt to secure a more effective absorption per surface area unit, either by increasing the absorptive surface area (structural adaptation) and/or slowing intestinal transit (functional adaptation). These changes are not still clearly established in humans, but there are so in animal models. The presence of nutrients within the intestinal lumen and certain gastrointestinal hormones, particularly GLP-2, have an influence on a successful adaptation process. Patients with SBS are prone to the occurrence of bacterial overgrowth that makes adaptation difficult and worsens the symptoms, besides being a factor for dependence on parenteral nutrition.
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PMID:[Short bowel syndrome: definition, causes, intestinal adaptation and bacterial overgrowth]. 1767 96


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