GI/ Nutrition

Question 1

What is the most common GI complication after head injury

Answer 1

Gastritis

Erosive gastritis is the most common lesion (74- 100% incidence)

Usually found in first week post injury

Question 2

Does the severity of head injury correlate with gastric stress erosions

Answer 2

Yes!

Brain injury is an independent risk factor for gastritis

Question 3

53 yo s/o tbi with hx DM. Elevated gastric residual volumes, abd distention and nausea.

Best treatment option?

Answer 3

Delayed gastric emptying

Best to: metoclopramide and erythromycin together

Question 4

What is recommended protein for acute tbi patients

Answer 4

1.5 and 2g/ kg accounts for excess protein catabolism

Provide at least 18 - 25% of calories in protein

Inflammatory mediators and catecholmines trigger hyper catabolism in TBI

Question 5

What is the most appropriate approach in attempting to control hyperglycemia during nutritional support for TBI patient

Answer 5

Blood glucose concentrations should be maintained at 100 to 180mg/ dl

Results in improved CSF glucose values and reduce risk of hypoglycemia

Hyperglycemia > 200 = predictor of poor outcome

Glucose levels bet 89 and 110mg/ dl may result in CSF values below normal threshold

Question 6

TBI patient with unexplained fever, vomiting, abdominal distended, lieu’s, RUQ pain and/ or developing intolerance to oral feeding?
Elevated bilirubin, all phos, liver enzymes and leukocytosis

Dx?
Best test to dx?
Treatment?

Answer 6

ACute acalculous cholecystitis

Usually 1wk - 1 month in patient hospitalized

Dx: HIDA scan,
US or CT abd

Tx: cholecystectomy/ broad spectrum abx

Question 7

42 y.o TBI with abd pain x 2 wks. + 50 lb weight loss. Pain worse after eating.
Better with rest/ lying in a lay wet Al decubitus position
No TTP, no peritoneal signs
LFTs normal.

What test should you do?

Answer 7

Superior Mesenteric artery syndrome

Dx: upper gastrointestinal series
Also CT or MRI angiography

Patient usually has dramatics weight loss. Postprandial abdominal pain. Occurs due to decreased oral intake, critical illness/ prolonged bed rest

Question 8

What is the most common complication of enteral tube feeding

Answer 8

Diarrhea

Formula composition
Rate infusion
Enteral formula contamination

Question 9

Damage in this part of the brain usually leads to bowel/ bladder incontinence

Answer 9

Frontal lobe- volitional control of bowel function
Incontinence usually related to decreased cognitive awareness.
Reflexes, spinal reflex arc and sensation typically intact