45 yr old male with bowel surgery

Posted By  HFHSM.D.-rf on March 08, 1998 at 22:30:53:

In Reply to: 45 yr old male with bowel surgery posted by Shailendra on February 25, 1998 at 04:54:05:

: Respected Sir/Madame,
                       I am a student in medical college.  Recently saw a
  case where a man was brought to hospital in abdominal distension and was
  in severe distress.  X-rays showed multiple fluid levels.  Routine tests
  were done.  RBS was 250 mg/dl.  Ketone bodies +ve (moderate) in urine.
  As the Rbs was going down without insulin being given (almost normal at
  time of operation) the on call duty doc decided to perform an operation.
  On opening the abdomen we were shocked to see that almost all the small
  and part of the large bowel was gangrenous.  The gangrenous parts were
  resected and a jejuno-transverso colostomy was performed.  THe patient
  is in the 3rd day of post-op and doing ok.  Parentral feeding being
  continued.
       WHat are his chances of living in the short term?  Can you give a
  good diet plan?  Are there any new medicines or food that can be of help?
  What do we do about the diarrhoea?  Why was RBS going down without us giving
  any insulin?
                   Thanking you,
                                 Shailendra
  

[HFHSM.D.-rf]

Dear Shailendra:
Mesenterc infarction is very dramatic condition.  I am certain that you have learned much from this case.  The first issue that must be addressed is the etiology for the mesnteric infarction.  Was there evidence for superior mesenteric artery occlusion by thrombus? Were the mesnteric veins thrombosed?  Did the patient have risk factors for mesnteric ischemia e.g. hypercoagulable stae, diabetes mellitus?
Diarrhea is a common condition early-on postoperatively.  Often the diarrhea will resolve.  The patient's ability to maintain his nutrition by enteral means will depend on how much small bowel is left.  I would attempt to feed him, initially using an isoosmotic elemental det.  I would try to control his diarrhea using antidiarhheals such as Imodium (immodium)/Lomotil or codeine.  You must remeber that since his ileocecal valve was resected, your patient is at increased risk of small intestine bacterial overgrowth. If the diarrhea is a problem, after he has been fed for a while, consider a seven dat course of an antibiotic such as oral tetracycline.  Also remember that he will requre vitamin B12 supplementation.
I can not explain why is blood glucose would fall, based on the information that you have provided.
Good luck with the care of your patient.
This material is provided for informational purposes only and should not be considered a formal medical evaluation.
HFHSM.D.-rf
keywords: mesenteric infarction
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