When TPN is Required

Patients will most likely require PN and fluids initially following massive bowel resection. This will continue for at least 7 to 10 days, and perhaps as long as 1 to 2 years during the adaptation process; it may be permanent if the bowel surface area and adaptation is insufficient. Patients should be provided with 30 to 33 kcal/kg/d (or use indirect calorimetry with an added activity factor) and 1.0 to 1.5 g/kg/d of amino acids. Energy is provided as dextrose (3.4 kcal/mL) and lipid emulsion (1.1 kcal/mL for the 10% and 2.0 kcal/mL for the 20% form). Requirements for young children and neonates are substantially greater. Electrolytes, minerals, vitamins, and trace metals are also to be provided. A further discussion of TPN requirements, management of the patient on TPN, and the management of TPN-related complications is found in Chapter 54, "Enteral and Parenteral Nutrition."

Surgical Approaches

There have been numerous reports of various bowel lengthening procedures and various other methods aimed at prolonging bowel transit time and nutrient-epithelium contact time. These have included the use of aperistaltic segments, attempts to increase surface area by "butterfly-ing" the bowel for lack of a better description, colonic interposition, reversed intestinal segments, and recirculating small bowel loops. Although there is the isolated case report of at least temporary success, none of these procedures have been considered routinely successful. All have been associated with the potential for significant morbidity.

Intestinal transplantation (discussed in Chapter 65, "Intestinal and Multivisceral Transplantation") is an option for patients that have developed severe, chronic complications of TPN therapy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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