CLINICAL CASES FOR THE EXAM 2 Surgical Nutrition PROBLEM 14 A 24 year old man who weighs 60 kgm has a three year history of Crohns disease. At the onset of his disease a distal small bowel resection and appendectomy were performed for perforation of the terminal ileum and abscess. Over the past two weeks he has developed fever, crampy, abdominal pain, diarrhea and occasional vomiting, and he has lost 10 pounds during this time. Physical exam reveals a pulse of 100, a temperature of 38.5oC, a blood pressure of 120/70. His abdomen is distended with active bowel sounds and minimal tenderness in the right flank. His laboratory studies reveal: Hb 13.5 Hct 40.2% WBC 18.9 bands 14 segs 76 lymphs 8 eoss 2 Albumin 2.7 gm/dl BUN 34 mg/dl Creatinine 1.4 mg/dl Total Bili 0.7 mg/dl Alk Phos 56 IU (within normal range) Study Questions: 1. What features of this patients condition are consistent with malnutrition? 2. How is the type and degree of malnutrition determined? 3. What effect, if any, does malnutrition have on the risk/benefit ratio of medical and surgical therapy for intestinal disease? 4. What are the options for nutritional support of this patient? PROBLEM 15 A 68 year old man underwent an elective sigmoid resection for carcinoma seven days ago. On day six a temperature to 39oC and lower abdominal pain prompted a CT scan of the abdomen which revealed a left lower quadrant abscess. The following day the abscess was drained percutaneously and 100 cc of foul smelling purulent material was removed. His abdomen is distended with few bowel sounds. He is anorectic. He has not had anything more than clear liquids by mouth since his operation. His albumin is 2.5 gm/dl. Study Questions: 1. What methods of nutritional support could be used for this patient? 2. What are the constituents of a typical 1,000 ml bottle of total parenteral nutrition? 3. What are the common metabolic complications that may occur during total parenteral alimentation? How are they recognized and treated?
Posted on: Tue, 25 Nov 2014 09:11:59 +0000
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