| Nutritional support is required for a substantial number of hospitalized patients and ranges from a simple assistance with meals, through enriched- or special-consistency diets, to enteral nutrition and total parenteral nutrition (Table 21.9).
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| Enteral nutrition entails feeding through special tubes placed in the stomach or jejunum, and parenteral nutrition is essentially intravenous feeding. Enteral nutrition is appropriate when there are difficulties with taking food orally but when the gastrointestinal tract functions properly.
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| When the gastrointestinal tract does not function because of, for instance, intestinal obstruction, or when large parts of it have been surgically removed, total parenteral nutrition is appropriate (see clinical box on p. 286).
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| Total parenteral nutrition, while in many instances life-saving, is a procedure potentially associated with complications caused by delivery (which requires strict sterility) as well as metabolic problems. For this reason, parenteral nutrition in hospitals is managed by multidisciplinary teams that include specialist nurses, surgeons, gastroenterologists, dieticians, pharmacists, and laboratory medicine physicians.
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