For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come without a significant risk of complications. For instance, parenteral nutrition-associated liver disease (PNALD)—a well-described cholestatic liver injury—and atrophic changes in the gut have both been described in patients receiving PN. Although several mechanisms for these changes have been postulated, data have revealed that the introduction of enteral nutrition may mitigate this injury. This observation has led to the hypothesis that gut-derived signals, originating in response to the presence of luminal contents, may contribute to a decrease in damage to the liver and gut. This review seeks to present the current knowledge regarding the modulation of what is known as the “gut–liver axis” and the gut-derived signals which play a role in PN-associated injury.
Background: To compare outcomes for complicated appendicitis treated with early versus interval appendectomy and to identify which patients would likely benefit from early appendectomy. Methods: A retrospective review of complicated appendicitis was performed from 2010 to 2015. Patients were divided into early (EA) versus interval appendectomy (IA) groups. We compared demographics, complications and outcomes. Pearson's Chi square analysis and Student's T test analysis were performed. Results: We identified 316 patients (EA group 53% vs. IA group 47%). Interval appendectomy group had longer symptom duration [IA 3.8 vs. EA 2.3 days (p Z 0.0001)], increased leukocytosis [IA 18.7 vs. EA 17.2 (p Z 0.008)], more initial abscesses [IA 35% vs. EA 13% (p Z 0.0001)], more complications [IA 30% vs. EA 19%, (p Z 0.013) and prolonged total length of stay [(LOS), p Z 0.009]. Subgroup analysis of all patients revealed 80% of patients presented with 3 cm abscess and duration of symptoms (DOS) 5 days. Interval appendectomy patients with DOS 5 days and or 3 cm abscess on admission had no differences in clinical presentation. However, these patients had prolonged total LOS (IA 7.7 vs. EA 6.3 days, p Z 0.01) and increased complications (IA 29% vs. EA 19%, p Z 0.04). Conclusion: The majority of patients with complicated appendicitis in children present with small abscess (3 cm) and short symptom duration (5 days). This subset of patients might
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