{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 25, Ep 2 of 3: Feeding, ERCP, and the Gallbladder","html":"","width":"100%","height":180,"duration":582,"description":"Episode two works through three first-days decisions where the intuitive older instinct turns out to be net harmful. Pancreatic rest with TPN increases infection because an empty lumen lets villi atrophy and gut bacteria translocate into necrotic tissue, so early enteral feeding wins. Universal urgent ERCP was wrong because most triggering stones have already passed, leaving an empty duct and only post-ERCP risk. And interval cholecystectomy costs roughly one in six patients a recurrent biliary event, so same-admission surgery is now standard. The unifying logic: each intervention earns its place against its own complication profile.\n \nTopics covered\n\nPancreatic rest versus early enteral feeding\nThe gut barrier and bacterial translocation\nFeeding rules in mild disease\nFeeding in predicted severe disease and tube level\nTPN as the failure path\nERCP indications and the passed-stone anatomy\nThe three-patient ERCP decision\nSame-admission versus interval cholecystectomy\nExceptions: severe disease and the non-surgical patient\n \n \nKey decisions\n\nFeed early in mild disease, within twenty-four to forty-eight hours, with a low-fat solid diet if the patient is hungry, has bowel sounds, and isn't vomiting, rather than holding NPO until the lipase normalizes.\nDo not force an early nasojejunal tube on predicted severe patients, since early nasojejunal placement showed no difference in major infection or mortality versus oral intake on demand.\nWhen a tube is needed, place a nasogastric tube and start feeding, because nasogastric, nasoduodenal, and nasojejunal feeding are equivalent and standard formulas work as well as elemental ones.\nReserve TPN for the patient who truly cannot tolerate enteral feeding for a prolonged period from severe ileus, hemodynamic intolerance, or surgical anatomy.\nPerform ERCP within twenty-four hours for cholangitis and within twenty-four to seventy-two hours for persistent obstruction, but give no ERCP to mild gallstone pancreatitis without...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}