Enteral nutrition can be provided either orally or by tube feeding. By definition enteral means “within or by the way of the gastrointestinal tract”. In practice enteral nutrition is generally considered as tube feeding (Figure1 & Figure 2).
Oral feeding is the best for the nourishment of a patient. But in the following conditions it is not possible to give the feeding orally and tube feeding or parenteral feeding is resorted.
- Those who cannot swallow due to paralysis of the muscles of swallowing (diphtheria, poliomyelitis) or cancer of the oral cavity or larynx.
- Those who cannot be persuaded to eat.
- Those with persistent anorexia requiring forced feeding.
- Semiconscious or unconscious patients.
- Severe malabsorption requiring administration of unpalatable formula.
- Short bowel syndrome.
- Those who are undernourished or at risk of becoming so.
- Those who cannot digest and absorb.
- After surgery.
- Patients with neurological and renal disorders or have chronic fevers or diabetes.
- Babies of very low birth weight.
This is done by passing a tube into the stomach or duodenum through the nose which is called nasogastric feeding or directly by surgical operation into stomach known as gastrostomic and into jejunum is called jejunostomic feeding.
A satisfactory tube feeding must be
- Nutritionally adequate
- Well tolerated by patient so that vomiting is not induced
- Easily digested with no unfavourable reactions such as distension, diarrhoea or constipation.
- Easily prepared and
||Foods to be included and avoided
|Foods included: All fibre richvegetables such as greens like amaranth, cabbage, lettuce, celery spinach, etc. special stress on raw vegetable salads. All fruits, with skins when tender whole grain cereals and breads with bran in fine division. Milk, meat, fish, fowl, eggs as desired for normal nutrition.
Foods to avoid: Highly refined and concentrated foods, fried foods, excessive amounts of coarse bran, excessive seasonings.
Intervals of feeding: three meals daily, water and fruit juices between meals before breakfast and before retiring.
|Soft moderately high fibre diet.
||When there is abnormal irritation of the intestines, bulk must be provided in smooth and finely divided form Spastic constipation Mucous colitis Peptic ulcer.
||Food included: modify soft diet to include only pureed fruits and vegetables in increased amounts.
Foods to avoid: see soft diet
Intervals of feeding: three to six small meals.
|Very low residue diet
||In severe diarrhoea the gastrointestinal tract needs to be given rest. Ulcerative colitis during initial stages of treatment. Preceding and following surgery on the colon or rectum when no movement is desired for several days. Partial intestinal obstruction.
||Foods include: Tender meat, fish, or fowl, clear fat free soups, fruit juices gelatin desserts, eggs, arrowroot cookies, refined cereals and breads, carbonated beverages, coffee, tea, butter and sugar.
Foods to avoid: Coarse breads and cereals; cheese, milk rich desserts, excessive sweets.
Intervals of feeding: Usually three meals daily.
To prevent stimulation of peristalisis and flow of gastric juice by mechanical or chemical irritation, and to reduce inflammation gastric and duodenal ulcers peptic ulcer.