Intestinal Failure Flashcards
What is intestinal failure?
Results from an inability to maintain adequate nutrition or fluid status via the intestines; eating and drinking no longer nourishes the person
Causes of intestinal failure?
From obstruction, dysmotility, surgical resection, congenital defect, or disease associated with loss of absorption
2 types of intestinal failure?
Acute - within 2 weeks of a procedure. Under this come Type 1 and Type 2 intestinal failure
Chronic - long-term, e.g: with short gut syndrome. AKA type 3 intestinal failure
Describe Type I intestinal failure
Self-limiting, short-term (days or weeks) post-operative or paralytic ileus
Describe Type II intestinal failure
Prolonged and associated with sepsis and metabolic complications; often related to abdominal surgery with complications
Describe Type III intestinal failure
Long-term but stable
Home parenteral nutrition is often indicated
Treatment of Type I intestinal failure?
Replace fluid and correct electrolytes
Parenteral nutrition if unable to tolerate food.fluids; this is for > or equal 7 days post-operative
They are not eating but still produce acids, so give PPIs
Ocreotide
When they improve, allow diet/enteral feeding
Methods of parenteral nutrition?
Dependent on venous access to veins of neck:
PICC (peripherally inserted central catheter)
Tunnelled catheter
Vascuport
Ultrasound-guided
Complications of parenteral nutrition?
Pneumothorax Arterial puncture Misplacement Sepsis SVC thrombosis Line fracture, leakage or migration Metabolic bone disease
Side effects (health and on life) of parenteral nutrition?
Nutrient toxicity/insufficiency, e.g: manganese
Liver disease
Metabolic disturbances, e.g: hyperglycaemia
Psycho-social impact
Inappropriate usage, e.g: for drugs
Treatment of Type II intestinal failure?
Parenteral +/- some enteral feeding
Causes of type II intestinal failure?
Surgical complications Motility Coeliac disease Crohn's disease Malignancy Vascular ischaemia Radiation enteritis, e.g: from radiotherapy
Treatment of Type III intestinal failure?
Home parenteral nutrition is the treatment of choice (often lifelong) and there is 80% survival at 6 years
Intestinal transplantation
GLP2 treatment for short bowel syndrome (regrow gut)
Bowel lengthening
What is short bowel syndrome?
Length of small bowel = 250-850 cm; a bowel
What is the most common indication for HPN in short bowel syndrome?
