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Liver Disease in Patients Qualified for Home Parenteral Nutrition – A Consequence of a Failure to Adjust Rtu Bags in the Primary Centre?

100%
Ławiński M., Bzikowska A., Omidi M., Majewska K., Zielińska-Borkowska U.
Polish Journal of Surgery
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2015
|
vol. 86
|
issue 6
279-284
EN
If planned improperly, parenteral nutrition may result in a number of severe metabolic complications caused by insufficient or excessive delivery of individual nutrients. One of the most common and the most dangerous complication is parenteral nutrition-associated liver disease (PNALD). Such a complication may also result from using RTU (ready-to-use) bags that are not adjusted adequately to individual patients. The aim of the study was the analysis of prevalence and determining the cause of liver disease in patients who had been receiving parenteral nutrition in primary centres prior to the implementation of home parenteral nutrition in the specialist centre. Material and methods. The study enrolled 146 patients who were referred to the Clinic in the period of 2006-2012 in order to be qualified for home parenteral nutrition. Interview and medical documentation revealed that 100 patients had been receiving parenteral nutrition by means of ready-to-use (RTU) bags in their primary centres. In the remaining 46 patients, such feeding had not been implemented. Upon admission, the following parameters were evaluated: bilirubin, aspartate aminotransferase (AspAT), alanine aminotransferase (AlAT), lactate dehydrogenase (LDH), gamma-glutamyltranspeptidase (GGTP), alkaline phosphatase (AP), triglycerides (TG), cholesterol, protein, albumins, amylase, urea, creatinine and C-reactive protein (CRP). The analysis of the results was conducted with the use of the Student’s T-test. Results. The patients who had been receiving parenteral nutrition manifested significantly increased (p < 0.05) levels of total bilirubin, TG, AlAT, LDH, GGTP, AP and CRP. 23% of patients were diagnosed with jaundice, in 70%, GGTP > 100 i.u. and a half manifested biochemical features of cholestasis. No correlation was observed between the CRP level and results of liver function tests. Conclusions. It was found that there is a correlation between parenteral nutrition with RTU bags and liver disease. The probable cause of liver disease associated with parenteral nutrition received prior to the transfer to the Clinic is excessive administration of lipids. It can be accompanied by excessive administration of glucose. Modification of parenteral nutrition helped to compensate for liver disorders in all patients
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Gastrojejunostomy Inserted Through Peg (Peg-J) in Prevention of Aspiration Pneumonia. Clinical Nutrition Complication in Dysphagic Patients

86%
Ławiński M., Gradowski Ł., Bzikowska A., Goszczyńska A., Jachnis A., Forysiński K.
Polish Journal of Surgery
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2015
|
vol. 86
|
issue 5
223-229
EN
Percutaneous endoscopic gastrostomy (PEG) is the most commonly used method of access to the gastrointestinal tract in long‑term home enteral nutrition (HEN) in patients with neurogenic deglutition and stenosis of the upper gastrointestinal tract caused by tumour. One of the most common complications of HEN is pneumonia resulting from aspiration of saliva or food. The risk of aspiration and the potential consequent sudden death is further increased by concomitant delayed gastric emptying and gastroesophageal reflux disease. The aim of the study was to evaluate the efficacy of changing percutaneous endoscopic gastrostomy to a gastrojejunostomy inserted through the PEG (PEG-J) in the prevention of aspiration pneumonia. Materiał and methods. The study involved 158 patients receiving HEN by percutaneous endoscopic gastrostomy (PEG), aged 19 to 90 years. Indications for enteral nutrition in the study subjects included: neurogenic dysphagia - 95 patients (60%), and obstruction of the upper gastrointestinal tract due to cancer - 63 patients (40%). Results. The pulmonary and gastrointestinal complications were observed in 28 patients receiving gastric nutrition through PEG within one to nine months following the start of the feeding. In 20 patients, because of the symptoms of aspiration pneumonia with accompanying gastroesophageal reflux and delayed gastric emptying, PEG was changed to PEG-J as an alternative. There were no reports on food reflux and aspiration pneumonia in patients whose PEG has been replaced by PEG-J. Conclusions. The use of PEG-J appears to prevent the occurrence of aspiration pneumonia in patients receiving home enteral nutrition in the long‑term
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