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Gastrointestinal > Intestinal failure > Flashcards

Intestinal failure Flashcards

1
Q

What is the definition of intestinal failure (IF)?

A

IF results from an inability to maintain adequate nutrition or fluid status via the intestines; the hydration and nutritional needs of the body are not met

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2
Q

What defines acute intestinal failure?

A

2 weeks

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3
Q

What defines chronic IF?

A

Long term condition - cannot eat for the rest of their life

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4
Q

Of the three types of IF, which are acute and which are chronic?

A

Type I and II are acute

Type III is chronic

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5
Q

What is type I IF?

A

Self-limiting, short term post-operative or paralytic ileus

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6
Q

Define ileus

A

Painful obstruction of the ileum or other part of the intestine

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7
Q

Where are patients with type I IF cared for?

A

Wards (HDU, ITU)

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8
Q

What is type II IF?

A

Prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications

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9
Q

Where are patients with type II IF cared for?

A

HDU, ITU, (wards)

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10
Q

What is Type III IF?

A

Long-term but stable - home parental nutrition often indicated

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11
Q

Where are patients with type III IF cared for?

A

Wards to home

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12
Q

Patients with Type I IF can be normal/moderately malnourished. What would you give?

A

Replace fluid, correct electrolytes
Parenteral nutrition if unable to tolerate foods/fluids >- 7 days post op
Acid suppression (proton pump inhibitor)
Octerotide
Alpha hydroxycholecalciferol to preserve Mg
Intensive multi-discplinary input
Allow some diet/enteral feeding

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13
Q

What is octreotide?

A

Man-made protein that is similar to the hormone somatostatin
Affects digestion through lowering levels of of insulin, glucagon, growth hormones and chemicals

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14
Q

What is Alpha hydroxycholecalciferol?

A

Vitamin D supplement given to preserve Mg

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15
Q

Why are acid suppressants given post-op?

A

The gut produces a lot of acid during surgery

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16
Q

What is parenteral nutrition (PN) dependent on?

A

Venous access

17
Q

What does PN involve?

A

Peripherally inserted central catheter (PICC)
Tunnelled catheter
Vascuport
Ultrasound (guide)

18
Q

What are complications of PN?

A

Sepsis, SVC thrombosis, line fracture, line leakage, line migration, metabolic bone disease, nutrient toxicity/insufficiency, liver disease, metabolic disturbance, pyscho-social and inappropriate usage

19
Q

What are the causes of Type II IF?

A

Septic patients, abdominal fistulae, perioerative who may develop a complication of feeding

20
Q

What is SNAP assessment of Type II IF?

A

Assess SEPSIS (major killer in these patients)
Manage fluid and electrolyte balance and provide NUTRITION
Radiological ASSESSMENT to find sepsis and fistula(e)
PLAN surgical management

21
Q

What are the treatment options for those with Type III IF?

A

Home parenteral nutrition (treatment of choice)
Intestinal transplant (specific infications, long term survival lower than HPN)
GLP2 treatment for SBS
Bowel lenthening

22
Q

What is short bowel syndrome?

A

Insufficient length of small bowel to meet nutritional needs without artificial support

23
Q

What is the normal length of the small bowel?

A

250-850 chm

longer in males than females

24
Q

What length defines short bowel syndrome?

A

<200 cm

25
Q

What is the most common indication for HPN?

A

Short bowel syndrome

26
Q

What length of bowel results in HPN being necessary?

A

<50cm of small bowel

27
Q

What are the survival chances once on HPN?

A

70% chance of being alive in 10 years

once on HPN you are on it for life

28
Q

What is the survival rate for those who receive an intestinal transplant?

A

50-60% 5 year survival

29
Q

What is the main advantage of intestinal transplantation over HPN?

A

The patient can eat

30
Q

What are the main indications for small bowel transplantation?

A

Loss of venous access and liver disease

Gastrointestinal (11 decks)

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