Escolar Documentos
Profissional Documentos
Cultura Documentos
OF
SUPERIOR MESENTERIC ARTERY
THROMBOSIS
Dana Magee
ARAMARK Distance Dietetic Internship
OVERVIEW
Disease Description
Nutrition Diagnosis
Interventions
Monitoring and Evaluation
Conclusion
http://emedicine.medscape.com/article/191560
-overview#showall
OCCLUSIVE MESENTERIC
ISCHEMIA
Embolus
Thrombosis
Quick onset
Gradual onset
Epidemiology
AMI accounts for .1% of hospital admissions in US
Mortality rate is 71% (AMA thrombosis is highest mortality
rate)
Bad breath
AFib
Signs of sepsis
SMA BLOCKAGE
Ischemia can lead to:
Vomiting and diarrhea
GI bleed
Necrotic bowel (8-12 hrs)
Bacterial overgrowth
Perforated bowel
Sepsis
HF
Multi- organ system failure
http://emedicine.medscape.com/article/191560overview#showall
DIAGNOSIS
Aortography gold standard
Distinguish between SMA thrombosis and embolism
CT scan / ultrasound
Not as specific or sensitive
Can see blockage of SMA
Can rule out other reasons for abdominal pain
TREATMENT
Immediate exploratory surgery
Remove ischemic/ necrotic bowel
Embolectomy
In surgery:
Peristalsis
Coloring
Doppler ultrasonography
IV fluorescent under Woodlamp
CASE PRESENTATION
Presented with abdominal pain out of proportion
http://web.uni-plovdiv.bg/stu1104541018/docs/res/skandalakis'%20surgical%20anatomy%20%202004/Chapter%2018_%20Large%20Intestine%20and%20Anorectum.htm
CASE PRESENTATION
CT scan showed SMA thrombosis
Started on TPN
Exploratory laparotomy
30 cm small bowel resected, NGT decompression
Second look surgery
GI bleed
Pacemaker
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. New England Journal of Medicine. 2011; 365 (6): 506-517.
Doi: 10.1056/NEJMoa1102662.
same rate at PN
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. New England Journal of Medicine. 2011; 365 (6): 506-517.
Doi: 10.1056/NEJMoa1102662.
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. New England Journal of Medicine. 2011; 365 (6): 506-517.
Doi: 10.1056/NEJMoa1102662.
Limitations:
No glutamine in PN or other modulators
Premixed PN
No indirect calorimetry
Not double blinded study
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. New England Journal of Medicine. 2011; 365 (6): 506-517.
Doi: 10.1056/NEJMoa1102662.
McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment of Nutrition Therapy in Adult Critically Ill
Patient. Journal of Parenteral and Enteral Nutrition. 2009; 33 (3): 285-290. Doi: 10.1177/0148607109335234.
Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in
critically ill surgical patients. Journal of Parenteral and Enteral Nutrition. 2008; 32 (4): 389-402. doi: 10.1177/0148607108317880.
cardiac/vascular/colonic surgery
Ages 18-80
s/p one of five surgeries
Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in
critically ill surgical patients. Journal of Parenteral and Enteral Nutrition. 2008; 32 (4): 389-402. doi: 10.1177/0148607108317880.
STD- PN
30 subjects
29 subjects
solution
Limitations:
Availability of glutamine- two time periods of
research
Limited number of postoperative PN
Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in
critically ill surgical patients. Journal of Parenteral and Enteral Nutrition. 2008; 32 (4): 389-402. doi: 10.1177/0148607108317880.
Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in
critically ill surgical patients. Journal of Parenteral and Enteral Nutrition. 2008; 32 (4): 389-402. doi: 10.1177/0148607108317880.
Academy of Nutrition and Dietetics. Recommendations Summary CIU: Supplemental Glutamine. Evidence Analysis Library.
http://andevidencelibrary.com/template.cfm?template=guide_summary&key=3201. Accessed March 22, 2013.
McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment of Nutrition Therapy in Adult Critically
Ill Patient. Journal of Parenteral and Enteral Nutrition. 2009; 33 (3): 285-290. Doi: 10.1177/0148607109335234.
Nutrition History
4 (anticipated TPN)
Weight Status
Dx/Condition
3 (anticipated GI surgery)
TOTAL POINTS
and 15g lipids to provide 1337 kcal, 80g protein, GIR 2.68 (81% of
nutritional needs)
Increase CHO in TPN to 255g.
formula/ solution
Anthropometric Measurements: Body weight
of GI function.
CONCLUSION
SMA thrombosis, NPO
CONCLUSIONS
Late initiation of PN linked to decreased LOS, time on dialysis,
REFERENCES
Dang CD. Acute Mesenteric Ischemia. Medscape.
REFERENCES
McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the Provision and Assessment
of Nutrition Therapy in Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition.
2009; 33 (3): 285-290. Doi: 10.1177/0148607109335234.
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill
adults. New England Journal of Medicine. 2011; 365 (6): 506-517. Doi:
10.1056/NEJMoa1102662.
Estivariz CF, Griffith DP, Luo M, et al. Efficacy of parenteral nutrition supplemented with
glutamine dipeptide to decrease hospital infections in critically ill surgical patients. Journal of
Parenteral and Enteral Nutrition. 2008; 32 (4): 389-402. doi: 10.1177/0148607108317880.
Academy of Nutrition and Dietetics. Recommendations Summary CIU: Supplemental
Glutamine. Evidence Analysis Library.
http://andevidencelibrary.com/template.cfm?template=guide_summary&key=3201. Accessed
March 22, 2013.
International Dietetics & Nutrition Terminology (IDNT) Reference Manual Third Edition.
Chicago, IL: American Dietetic Association; 2011.
ARAMARK. Patient Food Services Policies & Procedures Volume IV. Updated March 10,
2010.
ARAMARK. Malnutrition Assessment & Diagnosis (DRG coding form).
Pronsky ZM, Crowe JP. Food Medication Interactions 16th Edition. Birchrunville, PA: FoodMedication Interactions; 2010.