Intestinal Failure Flashcards
what is the definition of intestinal failure?
when gut is no longer able to supply the hydration and nutrition needs of the body
what types of intestinal failure are acute?
type 1 and 2
what types of intestinal failure are chronic?
type 3
what is type 1 intestinal failure?
self-limiting short term postop or paralytic ileus
what is type 2 intestinal failure?
prolonged, associated with sepis and metabolic conditions
often related to abdo surgery with complications
what is type 3 intestinal failure?
long term but stable
for what type of intestinal failure i home parenteral nutrition most likely to be indicated?
type 3 intestinal failure
what is the management of type 1 intestinal failure?
-replace fluid and correct electrolytes
-parenteral nutrition if unable to tolerate food/fluids 7+ days post op
(but allow as much enteral feeding as possible)
-acid suppresion (PPIs)
-octreotide
-alpha hydroxycholecalciferol
what is the purpose of octerotide?
reduced number of bowel movements
what is the purpose of alpha hydroxycholecalciferol?
preserves Mg (diarrhoea can make you deficient)
why is acid suppression needed in type 1 intestinal failure?
because it is likely to be post op- operations on gut cause patient to produce a lot of acid
what are the 3 main types of venous access for parenteral nutrition?
peripherally inserted central catheter (PICC)
tunnelled catheter
vascuport
what imaging technique is used usually for guiding venous access for parenteral nutrition considering the tip of the catheters should rest in the SVC?
ultrasound-guided
what are the 3 main complications of obtaining venous access for parenteral nutrition?
pneumothorax
arterial puncure
misplacement
what is the biggest complication worry with parenteral nutrition and why?
sepsis
line is just above the heart so there is an infective endocarditis risk
describe a SNAP assessment of a patient with type 2 intestinal failure?
- assess Sepsis
- manage fluid/electrolyde balance and provide Nutrition
- radiological Assessment to find sepsis and fistula
- Plan surgical management
what radiological tools are used to find fistulas?
CT scan
fistulography
what is the cause of short gut syndrome?
the gut has been ressected during surgery and has been left with too little of small bowel to provide enough nutrition/hydration for bodies requirements
what is the average length of small bowel?
250- 850cm
how short is the small bowel in short bowel syndrome?
usually below 200cm
what is the main benefit of HPN over intestinal transplant?
greater 5 year survival than patient who got an intestinal transplantation
what is the main benefit of intestinal transplant over HPN?
ability to eat
what are the 2 main indications for small bowel transplantation instead of HPN?
no more veins for venous access
liver disease
