A 45-year-old patient is admitted to the hospital with severe malnutrition and complications that prevent normal oral or enteral feeding. The medical team is considering parenteral nutrition to manage the patient’s nutritional needs.
What is the commonest indication for parenteral nutrition?
A. Esophageal cancer
B. Acute diarrhea
C. Paralytic ileus
D. Massive gut resection
E. Pyloric obstruction
Answer:
The Correct Answer is: D. Massive gut resection
Explanation:
Massive gut resection (D):
– Parenteral nutrition is commonly indicated in patients who have undergone massive gut resection. This condition can result in short bowel syndrome, where the remaining bowel is insufficient to absorb nutrients adequately. Parenteral nutrition provides the necessary nutrients directly into the bloodstream, bypassing the gastrointestinal tract, and is essential for maintaining nutrition in these patients.
Explanation of Incorrect Options:
Esophageal cancer (A):
– While esophageal cancer can impair swallowing and may require nutritional support, enteral feeding methods such as gastrostomy or jejunostomy tubes are often preferred before resorting to parenteral nutrition.
Acute diarrhea (B):
– Acute diarrhea typically does not require parenteral nutrition unless it leads to severe dehydration and electrolyte imbalances that cannot be managed by oral or enteral routes. Most cases can be managed with rehydration and correction of electrolyte imbalances.
Paralytic ileus (C):
– Paralytic ileus, a condition of temporary cessation of bowel peristalsis, may require temporary parenteral nutrition if prolonged. However, it is not as common an indication as massive gut resection because paralytic ileus is often self-limiting or manageable with supportive care.
Pyloric obstruction (E):
– Pyloric obstruction can impede gastric emptying but can often be managed with enteral feeding via a feeding tube placed past the obstruction. Parenteral nutrition is not the first line of treatment in these cases.
In conclusion, the commonest indication for parenteral nutrition is massive gut resection, making option D the correct answer.