Enteral Feeding After Gastric Intestinal Resection

Enteral Feeding After Gastric Intestinal Resection Optimum nutrition has always been a major target of post: operative care. Ileus is a common phenomenon after abdominal surgery, therefore early oral feeding is avoided and nasogastric decompression is being used. Conventionally, post abdominal surgery, the passage of flatus, or bowel movement was the clinical evidence of starting an oral diet. The end of post operative ileus based to be taken by the passage of flatus usually occurred within 5 days. The many studies have proved that the routine use of a nasogastric tube after abdominal Surgery and colorectal surgery may not be necessary. studies were undertaken to evaluate /whether different abdominal surgeries could benefit from early feeding. Early feeding improves the outcome of the patients with trauma and Burns although few studies have examined its use after gastro intestinal anastomosis. In case of laparoscopic colectomy patients have been fed routinely on day 2 after operation and that is being safely tolerated by the majority of patients. There are many evidences which indicate that immediate feeding after operation is actually feasible and safe whether post laparoscopic or post laparotomy , including gastro intestinal surgery. It has been proved by many studies that early enteral feeding in surgical patients improves nutrition and immunity and ultimately reducing septic complications and over all morbidity when compared with parenteral nutrition. A study conducted that compared an early regular diet to conventional post operative dietary management to determine G1 complications and mortality after major G1 anastomosis. The aim of this study was to assess the safety and tolerability outcomes of early oral feeding after elective gastro intestinal anastomosis. Patients and Methods Between July 2006 and December 2009, after the study was approved by ethical review committee, patients were offered participation and informed consent taken. Patients with chronic liver disease or those with metastasis and patients with histories of acute obstruction, perforation and intra abdominal infection were excluded. Patients were subject to a thorough history, physical examination and investigations. The patients were then randomized into two groups. Randomization done using sealed envelopes. Group 1 (Early feeding); 30 patients were offered simply a liquid diet within 6 hours of arrival on the ward. If 1 liter was being tolerated they were free for free liquid on the second day and then regular diet on the third day. (Tolerance is being indicated by an absence of vomiting or abdominal distension). Group 2 (Regular feeding) 30 patients were managed conventionally (that is nothing by mouth until the resolution of ileus, then a fluid diet, followed by regular diet. All patients underwent general anesthesia no nasogastric tube was inserted in any patients during surgery in patients in group 1 and a nasogastric tube was inserted in all patients during surgery and continued till the resolution of ileus in group 2. The patients were monitored for vomiting, abdominal distension length of ileus, tolerance of regular diet, length of hospitalization and complications. If there were two episodes of vomiting in the absence of bowel sounds or passage of flatus in the absence of any bowel movement, insertion of nasogastric tube was implemented.Also those who suffered from abdominal distension, emesis and succussion splash of stomach were diagnosed with acute dilatation of stomach, subjected to G I decompression. If there was anastomosis failure, treatment ensued such as antibiotics, nutritional support, ileostomy or colostomy. Patients with normal post operative course were discharged when they could tolerate a regular diet. Demographics were age and sex, medical and surgical histories of the patients and indications for anastomosis were noted. Different patients had different types of anastomosis were randomly allocated to group 1 irrespective of anastomotic type to eliminate bias. Table 1. Indications group 1 group 2 Tuberculous 5 5 Stricture at Ileum Closure of 20 20 Ileostomy Colorectal surgery 5 5 The main outcome was to evaluate post operative complications that included wound infection, leakage of anastomosis, obstruction, mesenteric emboli, upper G1 bleeding, wound dehiscence, prolonged ileus, and mortality. Ileus was defined as hypoactive bowel sounds, abdominal distension and no passage of flatus or bowel movement with or without nausea or vomiting after the first post operative day 3. Statistical analysis of data done by SPSS version 10. For continuous variables, descriptive statistics were calculated and were reported as mean +SD. Categorical variables were described using frequency distribution. The student T-test for paired samples was used to detect difference in the mean of continuous variables and the chi-square test was used in cases with low expected frequencies (a P value

Free Things They Carried Essays: Very Deep and Touching :: Things They Carried Essays

The Things They Carried: Very Deep and Touching   If anyone knows anything about Vietnam it is that many lives where lost.   All through school students were only taught the very top layer about the Vietnam War, such as dates, places that the war took place, and straight statistics of the war.   The parts that were left out are the tragedies, and the permanent scars this war left.   Students are told about the number of deaths that occurred, but they are not told about the lives that were affected, or how disturbing the war really was to the soldiers that fought in it.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Much can be interpreted by what people write.   The great thing about interpretations is that each writing can be interpreted differently.   Just like Tim O'Brien's book titled "The Things They Carried."   It is a very deep and touching collection of stories about the Vietnam War and many   peoples experiences in this destructive war.   One story that is a touching and very intriguing is titled, "The Man I Killed."   A reader can look at this story and relate it back to things they learned in school, but   the point of the story is not this but rather things that can not be taught in public schools.   This specific story goes inside a soldier's mind and shows the reader what they are thinking when they kill someone.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The way that O'Brien starts this story is with great description that helps the reader visualize what is going on.   He describes a mangled body that someone had recently killed; again not part of teachings in public schools.   The story goes on to tell what the victims background may have been in the eyes of the soldier.   How maybe he was a scholar and his parents farmers, or maybe why this young man was in the army, and why he was fighting.   O'Brien states that the man may have joined because he was struggling for independence, just like all the people that were fighting with him, maybe this man had been taught from the beginning; that to defend the land was a mans highest duty and privilege.   On the other hand maybe he was not a good fighter, maybe he was in poor health but had been told to fight and could not ask any questions.   These are all reasons that are taught in textbooks; they go along with the idea of the draft.

Diwali Is the Festival Closet to My Heart Essay

Diwali is the festival closest to my heart. It embraces all religions and it not only illuminates houses but also lives. This year was no different with my entire city karnal getting adorned over the last weekend to glowing LEDs while candles played a minor role in some houses. A significant and traditional part of this festival is crackers. They have only evolved over the years and presently you’ll be spoilt for choice shopping for them. However some enlightened minds have planted the seed of a polemic whether these crackers should be banned or not. India is witnessing a sorry state. In this country celebrities run over pedestrians and walk free. Ironically they run NGOs to assist the needy! A parallel can be drawn to politicians, bureaucrats and every member of the society. It is thus not surprising to find people squandering money all round the year but raising moral issues when it comes to bursting crackers. Some benevolent ones choose to abstain from them and do charity instead. What fails to pervade them is that these crackers are manufactured by dirt poor people who look forward to this festival all through the year for their livelihood. Why not do charity by purchasing their products? Another matter of grave concern is environmental pollution. Despite laws being enforced sound pollution hasn’t been curbed and the state police remain a mute spectator. The air pollution too is on a mammoth scale. But for a state topping the charts on the air pollution barometer, another drop in the ocean shouldn’t matter much. Diwali is the festival of lights and crackers constitute its focal point. The onus is upon us to celebrate responsibly by staying within the decibel limit. Otherwise we can keep these debates aside for one day and indulge in the ultimate aesthetic and entertaining aspect of this festival – crackers!

On Aristotles Friendship and Social Network - 10537 Words

CHAPTER I A. INTRODUCTION Technology is changing the world in a fast pace. This is evident most especially in social networks. Due to the widespread and growing use of these new social media, especially social networking sites such as Facebook, researchers began to study its ethical implications. Social networking services or social networking sites are widespread in all parts of the world. It serves as means of communication and is considered as the most convenient and easiest way of communication. It is convenient in a way that it is better than other means of communication such as telephone. In social networking sites, there is a video call and the one being called and the one calling can see each other. It is easy by the fact†¦show more content†¦There can still be other questions that can help the researcher arrive at the right answer to the main problem. However, the researcher will give more emphasis on the above-mentioned questions. As the research progresses, the researche r will post substantial questions that can be beneficial to answer the main problem. The researcher will answer the said questions in the light of theoretical and practical reason. The researcher will conduct simply survey to be able to arrive at the proper conclusion. C. SCOPE AND LIMITATION The study focuses on Aristotelian ethical principles applied to Facebook. These ethical principles are mainly about Aristotle’s concept of friendship. The researcher includes the discussion of virtue and other ethical principles governing friendship as support to the said topic. There are several ethical principles that can be applied to Facebook such as Confucian ethics and Heideggerian concept of technology but the researcher prefers Aristotelian ethical principles for the said topic. The study will tackle Aristotle’s concept of friendship with the inclusion of virtue and other ethical principle substantial on the discussion of friendship. The study will be limited to Facebook particularly the online friendship it offers. This Aristotelian concept and other ethical principles supporting it will be used in order to explain how the online friendship offered byShow MoreRelatedEssay Aristotelian’s Normative Concept of Friendship1475 Words   |  6 PagesIn Books VIII and IX of Aristotle’s Nicomachean Ethics, the normative concept of friendship is precisely defined and separated into various categories of which Socrates’ and Alcibiades’ relationship can be ascribed to. To achieve this endeavor, one will need to understand Aristotle’s notion of perfect friendship based on reciprocal goodwill and virtue, and imperfect friendship based on utility and pleasure. 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