Two interesting cases

I had two interesting patients on friday.

1. End stage scleroderma: no organ system of the patient's is working. Her GI is now non-functional and we are formulating a TPN. She also just had to go on the vent for a little while so we had to recalculate her needs because they are now less. It is quite an intense disease, they will probably be talking with the family about comfort care soon. She is in her early 50s.

2. Mesenteric ischemia: apparently this is quite rare. The patient came in with abdominal pain and a non-functional gut. She under went extensive revascularization with the aorta and the celiac arteries so her insides are all twisted up in crazy ways now! However, the surgeon is predicting she will have an ileus so I formulated a TPN recommendation for her. My RD wants to eventually suggest trickle enteral feeding to maintain gut integrity but she says surgeons just need one recommendation at a time or they get overwhelmed and TPN was going to have to happen no matter what. But we will see if she has an ileus tomorrow.