Splanchnic & GI physiology — Viva

Viva Stems

1. Day 1 after oesophagectomy the SMA flow is down — start feeds or wait? The 30-patient ultrasound cohort showed SMA 81% and SMV 85% of fasting on day 1 with recovery from day 2, no physical finding correlating, and flow rising when enteral nutrition started — so day-1 caution with prompt resumption as flow recovers, not a physical-exam clearance rule.^[1]

2. What drives postprandial SMA hyperaemia at mediator level? In anaesthetised male rats GLP-2/GIP acutely raised SMA flow independent of NO synthase and VIP receptors, antagonised by GLP-2(3-33) — a rat-exact mechanism, not a human dose-response curve.^[2]

3. Lactate is rising on vasopressors — is the gut victim, perpetrator, or both? In myocardial ischaemia-reperfusion mice plus 15 mmol/L lactate in vitro, lactate drove M1 polarisation injuring co-cultured gastric cells — so weigh gut injury as well as hypoperfusion when lactate climbs (mouse-and-cell-exact).^[3]

4. Pancreatic fluid collection with SVT needs drainage — does thrombosis change the plan? In 50 prospective patients SVT (36%) did not raise bleeding, complications or mortality after drainage — proceed on anatomy and physiology, quoting the cohort rather than inflating risk.^[4]

5. Family asks whether gut flora affect confusion after surgery. The neurosurgical POCD review links perioperative dysbiosis to cognitive risk with a probiotic signal in RCTs but calls for large trials; sodium butyrate's benefit is aged-mouse-exact (astrocyte inhibition, lower IL-1β/IL-6/TNF-α) — counsel honestly without prescribing a human regimen.^[5][6]

6. Name the exam traps. Quoting human SMA numbers from rats, human delirium doses from aged mice, forbidding drainage for SVT against the prospective no-difference result, or clearing feeds by physical exam against the cohort's no-correlation finding — each is a viva fail.^[1][2][4]