Intestinal Failure

Question 1

what is the definition of intestinal failure?

Answer 1

when gut is no longer able to supply the hydration and nutrition needs of the body

Question 2

what types of intestinal failure are acute?

Answer 2

type 1 and 2

Question 3

what types of intestinal failure are chronic?

Answer 3

type 3

Question 4

what is type 1 intestinal failure?

Answer 4

self-limiting short term postop or paralytic ileus

Question 5

what is type 2 intestinal failure?

Answer 5

prolonged, associated with sepis and metabolic conditions

often related to abdo surgery with complications

Question 6

what is type 3 intestinal failure?

Answer 6

long term but stable

Question 7

for what type of intestinal failure i home parenteral nutrition most likely to be indicated?

Answer 7

type 3 intestinal failure

Question 8

what is the management of type 1 intestinal failure?

Answer 8

-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

Question 9

what is the purpose of octerotide?

Answer 9

reduced number of bowel movements

Question 10

what is the purpose of alpha hydroxycholecalciferol?

Answer 10

preserves Mg
(diarrhoea can make you deficient)

Question 11

why is acid suppression needed in type 1 intestinal failure?

Answer 11

because it is likely to be post op- operations on gut cause patient to produce a lot of acid

Question 12

what are the 3 main types of venous access for parenteral nutrition?

Answer 12

peripherally inserted central catheter (PICC)
tunnelled catheter
vascuport

Question 13

what imaging technique is used usually for guiding venous access for parenteral nutrition considering the tip of the catheters should rest in the SVC?

Answer 13

ultrasound-guided

Question 14

what are the 3 main complications of obtaining venous access for parenteral nutrition?

Answer 14

pneumothorax
arterial puncure
misplacement

Question 15

what is the biggest complication worry with parenteral nutrition and why?

Answer 15

sepsis

line is just above the heart so there is an infective endocarditis risk

Question 16

describe a SNAP assessment of a patient with type 2 intestinal failure?

Answer 16

1. assess Sepsis
2. manage fluid/electrolyde balance and provide Nutrition
3. radiological Assessment to find sepsis and fistula
4. Plan surgical management

Question 17

what radiological tools are used to find fistulas?

Answer 17

CT scan

fistulography

Question 18

what is the cause of short gut syndrome?

Answer 18

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

Question 19

what is the average length of small bowel?

Answer 19

250- 850cm

Question 20

how short is the small bowel in short bowel syndrome?

Answer 20

usually below 200cm

Question 21

what is the main benefit of HPN over intestinal transplant?

Answer 21

greater 5 year survival than patient who got an intestinal transplantation

Question 22

what is the main benefit of intestinal transplant over HPN?

Answer 22

ability to eat

Question 23

what are the 2 main indications for small bowel transplantation instead of HPN?

Answer 23

no more veins for venous access

liver disease