Intestinal Failure Flashcards
What is intestinal failure?
It results from the inability to maintain adequate nutrition or fluid status via the intestines
How can inststinal failure occur?
By obstruction, dysmotility, surgical resection, congenital defect, or diseases associated loss of abdoption
What is intestinal failure characterised by?
The inability to maintain protein-energy, fluid, electrolyte or micronutrient balance
Describe simply what intestinal failure is?
Where the gut can no longer supply the hydration and nutritional needs of the body
What would acute/short term intestinal failure be classes as (Time wise)?
Around 2 weeks
What types of intestinal failure are classed as acute IF?
Type 1 and 2
What type of intestinal failure is class as chronic?
Type 3
What might be the cause of acute IF?
Mucositits post chemotherapy
What might be the cause of chronic IF?
Short gut syndrome
What is type 1 IF?
definition
Self-limiting short term, postoperative or paralytic ileus
What is type 2 IF?
definition
Prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications
What is type 3 IF?
definition
Long term but stable - home parental nutrition often indicated
What is paralytic ileus?
Paralytic ileus is the occurrence of intestinal blockage in the absence of an actual physical obstruction. This type of blockage is caused by a malfunction in the nerves and muscles in the intestine that impairs digestive movement.
How would you treat someone with type 1 IF?
They are usually normal/moderately malnourished
Replace fluids and correct electrolytes
Paraental nutrition if unable to tolerate oral foods/fluid
PPI ( acid suppression)
Octreoitide
Alpha hydroxycholecalciferol to preserve Mg
Intensive multi-disciplinary input
Allow some diet / enteral feeding
What is parenteral nutrition?
Parenteral nutrition (PN) is the feeding of a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, salts, amino acids, lipids and added vitamins and dietary minerals.
What might be some complications of parenteral nutrition?
Pneumothorax, arterial puncture/misplacement
Sepsis SVC thrombosis Line leakage/migration/fracture Nutrient toxicity/insufficiency Liver disease
What might be the different ways of venous access devices?
Peripherally inserted central catheter
Central venous catheter
- subclavian vein insertion
- internal jugular vein insertion
Describe what type of patients might have type 2 IF?
Septic patents - unwell for weeks, can’t eat and get type 2
Perioperative who may develop a complication of feeding
Usually not until several days after the op
How might you treat someone with type 2 IF?
Parenteral +/- some enteral feeding
Describe the difference between enteral and parenteral feeding?
Enteral nutrition generally refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a person’s caloric requirements. … Parenteral nutrition refers to the delivery of calories and nutrients into a vein.
What is the treatments for type 3 IF?
Home parenteral nutrition - treatment of choice
Intestinal transplantation - specific indications
(GLP2 treatment for SBS)
(bowel lengthening - not validated in adults yet)
What might be some diseases that lead to type 3 IF and leave you normal/mod malnourished but stable?
Crohn’s disease
Short gut syndrome
Neoplasia
Vascular
Mechanical
What is neoplasia?
The presence or formation of new, abnormal growth of tissue.
What is the normal length of the short bowel?
Length of the small bowel is between 250-850cm
Males longer than females
