Intestinal Failure

Question 1

What is intestinal failure?

Answer 1

Results from an inability to maintain adequate nutrition or fluid status via the intestines and is characterised by the inability to maintain proteinn-energy, fluid, electrolyte or micronutrient balance

Question 2

What can cause intestinal failure?

Answer 2

Obstruction, dysmotility, surgical resection, congenital defect, or disease associated loss of absorption

Question 3

What is type 1 IF?

Answer 3

Self-limitig short term postoperative or paralytic ileus

Question 4

What is type 2 IF?

Answer 4

Prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications

Question 5

What is type 3 IF?

Answer 5

Long term but stable - HPN often indicated

Question 6

What can cause type 1 IF?

Answer 6

Surgical ileus (bowel stops peristalsing), critical illness (severe sepsis, abscess), GI problems: vomiting, dysphagia, pancreatitis, GI obstruction, diarrhoea, oncology (chemo/DXT/GVHD

Question 7

How is type 1 IF managed?

Answer 7

Replace fluids, correct electolytes
PN if unnable to tolerate oral fluids/foods for more than 7 days post op
Acid suppression: proton pump inhibitors to decrease amount of gastric secretions
Octerotide - decrease pacreatic secretions

Question 8

What can cause type 2 IF?

Answer 8

Post-surgery awaiting recostruction 
Disaster (trauma) 
Crohn's 
SMA
Radiation 
Adhesions 
Fistula

Question 9

How ia type 2 IF managed?

Answer 9

Weeks/months of care in ICU/HDU

PN and NG tube

Question 10

What can cause type 3 IF?

Answer 10

SBS, crohn’s, radiation, dysmotility, malabsorbtion (scleroma, CV immunodef), inoperable cancer

Question 11

How is type 3 IF managed?

Answer 11

HPN
Intestinal transplantation
GLP2 treatment
Bowel lengthening - STEP, Bianchi

Question 12

When is HPN indicated?

Answer 12

Chronic intestinal failure

Normal/mildly malnourished but stable (SBS, crohn’s, neoplasia, vascular, mechanical, radiation enteritis, dysmotility)

Question 13

What defines SBS?

Answer 13

If the small bowel is less than 200cm it is described as being short
If less than 50cm then HPN is required

Question 14

What can cause SBS?

Answer 14

Small intestinal resections (crohn’s, post irradiation enteritis, repeated surgery for surgical complications)
Massive intestinal resection (infarction - SMA, SMV thombosis, massive volvulus, desmoid tumour)
EC fistula
Bypass surgery

Question 15

What are the types of stoma?

Answer 15

Jejunostomy
Ileostomy
Jejuno-colic anastomosis
Ileo-colic anastomosis

Question 16

How can PN be giver?

Answer 16

Peripherally via a PVC

Centrally via PICC, Hickman line, vascuport

Question 17

What are the complications ofinserting a central line?

Answer 17

Pneumothorax
Arterial punncture
Misplacement

Question 18

What are some complications of PN?

Answer 18

Sepsis
SVC thrombosis
Line fracture, leakage and migration 
Metabolic bone disease (osetoporosis) 
Nutrient toxicity
Liver disease 
Psycho-social

Question 19

Who is involved in the nutritional support team?

Answer 19

Dr (GI, surgeon) 
Specialist nurse
Dietitian 
Pharmacist
Biochemist