flora Kokwaro

My professional site but geeky gastro side. #love gastro

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ setting up clear advanced directive planning comes into play here

#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Important to think about life expectancy in metastatic cancer in considering PN .

Are they getting palliative chemo?

What symptoms are they having as well ?

what complications from the cancer in regards to GI dysfunction

#FGDebate

[flora Kokwaro @FKokwaro]

Life expectancy in the context of metastatic disease comes in to play when considering palliative PN

[Frontline Gastro @FrontGastro_BMJ]

4. As FG undergoes her transplant assessment, she is sadly found to have metastatic breast cancer. She is referred to palliative care who ask for a plan for her pn. What do you advise? #FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Nutrition nurses have clever ways of organizing compatible mobile bags for patients to adapt to travel .

Literally PN on wheels

Equipment comes in more compatible ways now.

#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Nutrition nurses have clever ways of organizing compatible mobile bags for patients to adapt to travel .

Equipment comes in more compatible ways now.

[flora Kokwaro @FKokwaro]

Nutrition definitely plays an important role in various aspects in not only gastroenterology but across various specialties.
We are seeing more patients with various disorders related to intestinal failure and need for nutrition support.
#FGDebate

[Aditi Kumar @dr_aditi_kumar]

Should UK trainees have min 6 month mandatory nutrition training in tertiary centre (like with liver training?) #FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ HPN complications to think about :

Catheter related blood stream infections
IFALD
Thromboembolic events – CVC related
Vascular stenosis
Metabolic bone disease
Renal disease
Quality of life and patient reported outcomes

#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ QOL on PN key aspect as well to remember to address in follow up
1. Physical impacts -
2. Emotional impact
3. Social impact
4. coping with life after short bowel syndrome and IF ( adaptation and support )
#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Begin to establish an education program for patients and/or caregivers to teach correct and proper HPN care

this is ongoing and continues to be
re-enforced in the community
#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Prior to discharge, patients should be ideally metabolically stable, able to physically and emotionally cope with
the HPN therapy, and have an adequate home environment.

#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Perhaps linking discussions with a HPN as well to aid in facilitating home set up.
Virtual MDT
#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ Assessments for type of PN , how long are key and need to get MDTs discussions going early to plan
#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ think types of intestinal failure

Type I Acute ( self limiting )

Type 2 Acute ( metabolically active )

Type 3 ( chronic )

#FGDebate

[flora Kokwaro @FKokwaro]

@FrontGastro_BMJ think types on intestinal failure to aid decision making

Type I Acute ( self limiting )

Type 2 Acute ( metabolically active )

Type 3 ( chronic )

[flora Kokwaro @FKokwaro]

Type I Acute ( self limiting )

Type 2
Acute ( metabolically active )

Type 3 ( chronic )

[flora Kokwaro @FKokwaro]

what category of Intestinal failure would you classify this in ?#FGDebate

[flora Kokwaro @FKokwaro]

#FGDebate

[flora Kokwaro @FKokwaro]

#FGDebate join as tonight for a lively debate on controversies in intestinal failure!
looking forward to this ! 8pm start

[flora Kokwaro @FKokwaro]

#frontline_gastro Coming soon #nutrition debate. This has got to be epic

[Elliot Tapper @ebtapper]

Paradigm shifts in portal hypertension

https://t.co/09KxG2FRPL from THE @ggarciatsao and @JuanAbraldes #LiverTwitter #cirrhosis