Intestinal failure Flashcards
What is the definition of intestinal failure (IF)?
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
What defines acute intestinal failure?
2 weeks
What defines chronic IF?
Long term condition - cannot eat for the rest of their life
Of the three types of IF, which are acute and which are chronic?
Type I and II are acute
Type III is chronic
What is type I IF?
Self-limiting, short term post-operative or paralytic ileus
Define ileus
Painful obstruction of the ileum or other part of the intestine
Where are patients with type I IF cared for?
Wards (HDU, ITU)
What is type II IF?
Prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications
Where are patients with type II IF cared for?
HDU, ITU, (wards)
What is Type III IF?
Long-term but stable - home parental nutrition often indicated
Where are patients with type III IF cared for?
Wards to home
Patients with Type I IF can be normal/moderately malnourished. What would you give?
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
What is octreotide?
Man-made protein that is similar to the hormone somatostatin
Affects digestion through lowering levels of of insulin, glucagon, growth hormones and chemicals
What is Alpha hydroxycholecalciferol?
Vitamin D supplement given to preserve Mg
Why are acid suppressants given post-op?
The gut produces a lot of acid during surgery
What is parenteral nutrition (PN) dependent on?
Venous access
What does PN involve?
Peripherally inserted central catheter (PICC)
Tunnelled catheter
Vascuport
Ultrasound (guide)
What are complications of PN?
Sepsis, SVC thrombosis, line fracture, line leakage, line migration, metabolic bone disease, nutrient toxicity/insufficiency, liver disease, metabolic disturbance, pyscho-social and inappropriate usage
What are the causes of Type II IF?
Septic patients, abdominal fistulae, perioerative who may develop a complication of feeding
What is SNAP assessment of Type II IF?
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
What are the treatment options for those with Type III IF?
Home parenteral nutrition (treatment of choice)
Intestinal transplant (specific infications, long term survival lower than HPN)
GLP2 treatment for SBS
Bowel lenthening
What is short bowel syndrome?
Insufficient length of small bowel to meet nutritional needs without artificial support
What is the normal length of the small bowel?
250-850 chm
longer in males than females
What length defines short bowel syndrome?
<200 cm
What is the most common indication for HPN?
Short bowel syndrome
What length of bowel results in HPN being necessary?
<50cm of small bowel
What are the survival chances once on HPN?
70% chance of being alive in 10 years
once on HPN you are on it for life
What is the survival rate for those who receive an intestinal transplant?
50-60% 5 year survival
What is the main advantage of intestinal transplantation over HPN?
The patient can eat
What are the main indications for small bowel transplantation?
Loss of venous access and liver disease
