alimentary disease

Question 1

2 strategies for when patients are unable to feed themselves

Answer 1

enteral feeding (delivery of nutritious fluid past upper GIT and into stomach/small intestine), parenteral feeding (bypassing GIT altogether and delivery of nutrients into blood via venous catheter)

Question 2

what patients would benefit from enteral feeding

Answer 2

upper GI problem (dysphagia or trauma), so they can’t chew and swallow food normally

Question 3

what patients would benefit from parenteral feeding

Answer 3

dysfunction GIT that is unable to digest, absorb or excrete appropriately (e.g. mid-GI blockage)

Question 4

complications of enteral feeding

Answer 4

low risk: nausea, vomiting, aspiration (food back up oesophagus from stomach)

Question 5

complications of parenteral feeding

Answer 5

high risk: blood clots, infection, liver failure

Question 6

enteral vs parenteral feeding: technical requirements

Answer 6

enteral: basic training; parenteral: specialist training

Question 7

enteral vs parenteral feeding: effect on GIT

Answer 7

enteral: maintains internal structure and function; parenteral: causes atrophy or structures through underuse

Question 8

enteral vs parenteral feeding: cost

Answer 8

parenteral is 5x more expensive

Question 9

what is short bowel syndrome characterised by

Answer 9

significant removal of bowel, leaving patient with less than 100cm of functional intestinal tract

Question 10

when is removal of bowel necessary

Answer 10

Crohn’s disease, cancer, ischaemia, ulcerative colitis, irradiation

Question 11

what does loss of bowel lead to

Answer 11

dehydration, malnutrition, and malabsorption of micro- and macronutrients

Question 12

what is major issue with short bowel syndrome

Answer 12

reduction in absorptive SA

Question 13

other issues with short bowel syndrome (small and large intestine)

Answer 13

loss of small intestine tissue interrupts usually efficient control of gut function via hormones and enteric nervous system; loss of large intestine tissue associated with increased risk of infection

Question 14

what is short bowel syndrome management focussed on (3 things)

Answer 14

provide adequate nutrition for patients; ensure adequate water and electrolytes to maintain homeostasis; correction and prevention of acid base imbalance

Question 15

what is the most important surgical intervention that can heavily reduce reliance on parenteral nutrition in short bowel syndrome

Answer 15

anastamosis of small intestine to colon