Type 2 diabetes mellitus, coronary artery disease, hypertension, deep venous thrombosis, pulmonary embolus, lymphedema thrombophlebitis, weight-bearing osteoarthritis (involving the hip, knees, ankles, and feet), low back syndrome, herniated disk, lower extremity edema, gallbladder disease, gastroesophageal reflux disease (GERD), asthma, sleep apnea, pseudotumor cerebri, cirrhosis, varicosities, intertriginous dermatitis, breast cancer, uterine cancer, prostrate cancer, and Pickwickian syndrome.

Reference: Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management, 7th ed. Philadelphia, W.B. Saunders, 2003.

This TPN solution clearly is lacking in vitamins and trace minerals. In a matter of weeks, the patient would be expected to develop deficiencies in magnesium, zinc, essential fatty acids, and water-soluble vitamins (with the exception of B12). Over several months, vitamin K and copper deficiencies would develop. Over a period of years, deficiencies in the fat-soluble vitamins A and D as well as selenium, chromium, and vitamin B12 would result.

Reference:   Rustgi AK (ed): The Requisites in Gastroenterology: Vol 1: Esophagus and Stomach. St. Louis, Mosby, 2003

The most common complications are related to catheter placement and management. Examples include infections, thrombosis, nonthrombotic occlusion, and other mechanical complications during line placement. Catheter-related complications can be minimized by maintaining strict and reproducible technique as well as meticulous line care.

Reference:  Rustgi AK (ed): The Requisites in Gastroenterology: Vol 1: Esophagus and Stomach. St. Louis, Mosby, 2003.

No. The diagnosis cannot be made simply by advising the patient to avoid dairy products for 2 weeks to determine if the altered bowel habits revert to normal because many patients who respond to these manipulations are actually not lactase deficient. The diagnostic test to be used is the lactose hydrogen breath test.

Reference:  Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management, 7th ed. Philadelphia, W.B. Saunders, 2003.

Lactase deficiency. Lactase-deficient adults retain 10-30% of intestinal lactose activity and develop symptoms (diarrhea, bloating, and gas) only when they ingest sufficient lactose. Symptoms result from the colonic bacteria metabolizing lactose to methane, CO2, and short-chain fatty acid.

Reference: Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management, 7th ed. Philadelphia, W.B. Saunders, 2003.

Severe folate deficiency occurs most often in association with chronic alcoholism, celiac sprue, tropical sprue, and blind loop syndrome. Minor deficiencies can be found in Crohn’s disease and following partial gastrectomy. Since folate absorption is largely completed in the upper small intestine, malabsorption is worse in disorders that affect the upper gut. However, any intestinal disorder accompanied by a decrease in dietary intake or rapid transport may result in folate deficiency.

Reference:  Rustgi AK (ed): The Requisites in Gastroenterology: Vol 1: Esophagus and Stomach. St. Louis, Mosby, 2003.

1. Thiamine: beriberi, muscle weakness, tachycardia, heart failure
2. Niacin: pellagra, glossitis
3. Vitamin A: xerophthalmia, hyperkeratosis of skin
4. Vitamin E: cerebellar ataxia, areflexia
5. Zinc: hypogeusia, acrodermatitis
6. Chromium: glucose intolerance

Reference: Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management, 7th ed. Philadelphia, W.B. Saunders, 2003