intestinal failure

Question 1

what is intestinal failure ?

Answer 1

reduction in the gut function below the bare minimum necessary for the absorption of nutrients where intravenous supplementation is required

Question 2

what is intestinal insufficiency ?

Answer 2

a reduction in the absorptive function that does not require IV supplementation to maintain health

Question 3

what are thew types of intestinal failure ?

Answer 3

type 1
type 2
type 3

Question 4

what are the features of type 1 intestinal failure ?

Answer 4

acute
short-term
usually a self limiting condition

Question 5

what are the features of type II intestinal failure ?

Answer 5

prolonged acute condition often in metabolically unstable patients and require IV supplementation over a period of timer

Question 6

what are the features of type 3 intestinal failure ?

Answer 6

chronic condition (CIF) in metabolically stable patients that require IV supplementation over a much longer period of time

Question 7

when is it common to see type 1 IF ?

Answer 7

after abdominal surgery (postoperative ileus)

Question 8

what is the management for type 1 IF ?

Answer 8

parenteral fluid and nutrition support

early mobilisation is encouraged

Question 9

when does type 2 IF happen ?

Answer 9

usually as a result of trauma
sepsis
complication of intestinal surgery
usually happens when there is a co-existing comorbidity

Question 10

what is the prognosis in type 2 IF ?

Answer 10

40% fully recover 50% develop type 3 IF

Question 11

what is the first step in management in a patient with type 2 IF ?

Answer 11

optimizing fluids and electrolytes and making sure the patient is haemodynamically stable

Question 12

how is nutritional support achieved with patients that have AIF ?

Answer 12

either by enteral or parenteral feeding

Question 13

what would be the drug of choice for hypergasteremia ?

Answer 13

omeprazole ( proton pump inhibitor )

Question 14

what drugs are known to decrease GI losses and increase absorption ?

Answer 14

anti motility therapy such as loperamide

Question 15

when should cholestryamine be considered ?

Answer 15

in patients with colon in continuity

Question 16

what drug can be used to decrease the enteral fluid load?

Answer 16

octeotride (somatostatin) due to its ability to promote intestinal absorption and inhibit gastric, pancreatic, and intestinal secretion

Question 17

what is the management for CIF type 3?

Answer 17

home parenteral nutrition

Question 18

what are the main drugs used in short bowel syndrome ?

Answer 18

antimotility drugs such as loperamide
antisecretory agents
teduglutide

Question 19

what is the mechanism of teduglutide ?

Answer 19

it is a GLP-2 analogue

increases absorptive capacity and inhibits gut motility and secretion

Question 20

when is teduglutide contraindicated ?

Answer 20

its contraindicated in active or suspected malignancy

Question 21

what are the side effects of teduglutide ?

Answer 21

abdominal pain
stomal complications
injections site reaction

Question 22

what are the indications of intestinal transplantation ?

Answer 22

1. failure of HPN
2. high risk of death attributable to the underlying disease
3. intestinal failure with high morbidity or low acceptance of HPN

Question 23

what are the signs of failed HPN ?

Answer 23

• impending or overt liver failure
• central venous catheter related thrombosis
• frequent central line sepsis
• frequent episodes of severe dehydration

Question 24

which underlying diseases would be an indication for intestinal transplantation ?

Answer 24

congenital mucosal disorders

ultra short bowel syndrome

Question 25

what measures are not recommended in order to prevent CVC related infections ?

Answer 25

use of in-line filters
routine replacements of catheters
antibiotic prophylaxis
use of heparin lock

Question 26

what is the most common cause of intestinal failure in children ?

Answer 26

short bowel syndrome