Intestinal failure Flashcards
What is intestinal failure?
This is the inability to maintain adequate nutrition or fluid status via the intestines
How many types of intestinal failure are there?
3
What is meant by type I intestinal failure?
This is intestinal failure caused by surgical ileus, critical illness or GI problems
What are some gastrointestinal problems that can cause type I intestinal failure?
Vomiting
Dysphagia
Pancreatitis
GI obstruction
Diarrhoea
Oncology (Tumour or chemo)
How is type I intestinal failure usually treated?
Usually short term and self limiting
Symptom Relief:
Fluid replacement
IV nutrition
Acid support (PPIs)
What is type II intestinal failure?
This is a reversible form of intestinal failure usually caused post surgery by adhesions, fistulae, vascular embolism, radiation or sepsis
How is type II intestinal failure usually treated?
IV fluid
Naso-gastric or oral feeding
What is type III intestinal failure?
This is short bowel syndrome, which is a s short bowel caused by a pathology of the bowel?
What are some causes of type III intestinal failure?
Crohn’s disease
Radiation
Dysmotility
Scleroderma
CV immunodeficiency
Inoperable cancer causing obstruction
Volvulus
Vascular disaster (Embolism)
How is type III intestinal failure usually treated?
Total parenteral feeding (IV) even at home
Intestinal transplantation
Ileostomy
Teduglutide in children
What are some bowel lengthening procedures available in type III intestinal failure?
The bianchi procedure
Serial transverse enteroplasty
What is the bianchi procedure?
This involves splitting the main lumen of the intestine into 2 smaller lumen, therefor increasing the surface area and decreasing the speed at which food moves through
What is serial transverse enteroplasty?
This involves forming projections within the small intestine, which increases surface area and decreases the speed at which food moves through
What is the usual length of the jejunum and ileum together?
6-7m
What length of functioning bowel is classified as short bowel?
< 2m
What length of functioning bowel is classified as ultra small?
<50 cm
What are the 4 main surgical procedures that can cause small bowel syndrome?
Jejunostomy
Ileostomy
Jejuno-colic anastomosis
Ileo-colic anastomosis
What are the 2 types of venous access in parenteral nutrition?
Central
Peripheral
How is peripheral PN feeding given?
Via a 22G blue cannula
This contains no lipids and reduced calories, so some oral or nasogastric feeding can be performed
How is central PN feeding given?
This is inserted via a PICC, a tunnelled catheter or portocath via ultrasound
What are PICC lines and where are they inserted?
Peripherally Inserted Central Catheter
Inserted into the arm and fed into the entrance to the right atrium
What are the 2 types of tunnelled catheters and where are they inserted?
Subclavian - Into the subclavian vein
Hickman - Into the internal jugular vein
Where are portacaths inserted?
They are inserted directly through the chest and into the right atrium
What are some complications with catheter insertion?
Risk of sepsis, occlusion, displacement or breakage
Also requires immunosuppression
