Thursday April 26, 2007

Q; What's the last resort of treating clostridium difficile when all other therapies fail and patient continue to have relapsing severe clostridium difficile infection ?

A; Stool Donation !!

Infusion of healthy stool (from donor) in patient's bowel via colonoscope, enema or a naso-jejunal tube. Sounds weird but idea is to restore human bowel flora. Actually, published reports shows that stool donation kills and eradicates C. diff. spores with a very high cure rate.

References:

Treatment of Recurrent Clostridium difficile-Associated Diarrhea by Administration of Donated Stool Directly Through a Colonoscope - Am J Gastroenterol. 2000 Nov;95(11):3283-5.

The effect of faecal enema on five microflora-associated characteristics in patients with antibiotic-associated diarrhoea. Scand J Gastroenterol 1999;34:580-6.

Tuesday April 17, 2007
Liver Complications of TPN

Although Parentral Nutrition is a lifesaving therapy in patients with gastrointestinal failure, its use may be associated with metabolic, infectious, and technical complications.

The overall frequency of PN associated liver complications ranges from 7.4% to 84%. Some 15–40% of adult patients receiving long-term PN therapy may develop end-stage liver disease. The wide variation in the reported frequency is the result of heterogeneity in the population studied, the duration and composition of PN, and the liver complications reported in the studies.

Mild to moderate elevation of liver enzymes is commonly seen within two weeks after starting PN, and should not lead to extensive workup unless warranted. Liver enzymes return to normal after PN is discontinued. With long-term PN, severe liver complications may occur, such as steatosis, steatohepatitis, cholestasis, and cholelithiasis. Although PN-associated cholestasis and hepatic steatosis can coexist, steatosis is more common in adults, while cholestasis is more common in children.