What would be the standard guidelines and subsequent ...

[kshipps]

What would be the standard guidelines and subsequent recommendations to begin weaning TPN and increasing enteral feeds?
 
  What will be an ideal response?

Question 2

Mr. Page was initially diagnosed with ulcerative colitis and then diagnosed with Crohn's. How could this happen? What are the similarities and differences between Crohn's disease and ulcerative colitis?
 
  What will be an ideal response?

[shoemake]

Answer to Question 1

The standard guidelines and subsequent recommendations for weaning TPN depend on when enteral feedings or PO intake has been advanced to >60 of estimated energy needs. Once this occurs and the patient is tolerating the alternate route of feeding well, the PN formula can be discontinued. Attention to glycemic control post-PN is important to monitor for hypoglycemia. If the patient has a history of hypoglycemia, however, it is reasonable to taper PN over 1-2 hours to avoid this problem. Overall, it is important to meet calorie needs through the transition of PN to EN for this patient in order to avoid complications with glycemic control or underfeeding.

Answer to Question 2

 UC and CD are very similar, but can be distinguished from one another by the following:
Symptoms
Complications
Antibody testing
Imaging and biopsy results

Crohn's disease Ulcerative colitis
Symptoms  Blood &/or mucus in stool
 Abdominal pain & cramping
 Fever
 Wt loss
 Chronic diarrhea
 Anorexia
 Malnutrition
 Delayed growth in adolescents  Bloody diarrhea with mucus
 Abdominal &/or rectal pain
 Fever
 Wt loss
 Possibly constipation & rectal spasm
 Arthritis
 Dermatological changes
 Ocular manifestations
Complications  Malabsorption
 Malnutrition
 Abdominal fistulas & abscesses
 Intestinal obstruction
 Bacterial overgrowth (blind loop syndrome)
 Gallstones
 Perianal disease
 Neoplasia
 Urinary tract infections
 Kidney stones
 Thromboembolic complications
 Affects any part of the GI tract (from mouth to anus) and may have a skipping pattern  Severe bleeding
 Toxic colitis
 Toxic megacolon
 Strictures
 Perforation
 Colonic structures
 Dysplasia
 Carcinoma
 Intolerance to immunosuppression
 Affects the colon and rectum only (continuous)
Diagnosis  Clinical presentation  CDAI score
 Abdominal ultrasound
 MRI
 CT
 Antiglycan antibodies (ASCA/ANCA)
 Calprotectin, lactoferrin, & polymorphonuclear neutrophil elastase  Abdominal ultrasound
 MRI
 CT
 Antiglycan antibodies (ASCA/ANCA)
 Calprotectin, lactoferrin, & polymorphonuclear neutrophil elastase

[kshipps]

Excellent

[bigcheese9]

Thanks for the timely response, appreciate it