Intestinal failure Flashcards
What is intestinal failure?
The inability to maintain adequate nutrition or fluid status via the intestines resulting in a need for IV supplementation through PE nutrition
What are the characteristics of intestinal failure?
Micronutrient , fluid, electrolyte imbalance,malabsorptions and lack of energy
You can get acute and chronic intestinal failure. What types come under which heading?
Acute = type 1 and 2 Chronic = type 3
What is type 1 IF?
Self limiting short term postoperative or paralytic ileus. Cared for on the ward
What is type 2 IF?
Prolonged, associated with sepsis and metabolic complication or abdominal surgery with complications. Cared for on HDU or ITC
What is type 3 Intestinal failure?
Long term but stable. Home parentral nutrition often indicated
What causes Type 1 IF?
Sepsis, GI problems with vomiting, dysphagia, pancreatistsi, obstruction, oncology (following chemo or radio therapy
How is type 1 IF treated?
Normally occurs in previously healthy individuals.
Replace fluid lost and correct electrolytes. PN if unable to tolerate food/fluids after 7 days
PPI, Octreotide, Alpha hydroxycholecalciferol
What is PPI used for in IF?
To reduce gastric secretions
What is Octreotide used for in IF?
Suppress pancreatic secretions
What is Alpha hydroxycholeciferol used for in IF?
Preserve Magnisium
What types of venous access can be used to give PN?
Blue PVC PICC line (peripherally inserted central catherter) up to 14 days Hickmann line (tunneled catheter) Vascuport (good for home PN) Often inserted with ultrasound guidance
What are the complications with establishing vascular access for PN?
Pneumothorax Arterial puncture or misplacement
WHy would you never give PN through veins below the waist?
Much greater risk of infection- you are essentially giving lots of glucose
Which vein is often used for PN?
Subclavian veins
What are the complications of PN?
Sepsis SVC thrombosis Line fracture/leakage/migration Metabolic bone disease Nutrient toxicity/insufficiency Liver disease (monitor liver function) Metabolic disturbance PSYCHOSOCIAL Inappropriate usage
What are the causes of type 2 intestinal failure?
Surgical complications (most common) Sepsis Abdominal fistula (crohn's), trauma or vascular event, SMA (superior mesenteric artery syndrome), Malignancy
What is superior mesenteric syndrome?
third and final portion of the duodenum is compressed between the abdominal aorta (AA) and the overlying superior mesenteric artery.
What is the treatment for Type 2 IF?
PN +/- some entral feeding and trying to wean them off it slowly.
What foods should people begin with when coming off PN?
Clear soups and fluids, jellys and high calorie supplementation drinks
What are the causes of type 3 IF?
Short Bowel syndrome (most common)
Crohns, malabsorption, dysmotility, inoperable Ca, Radiation (prostate/ovarian cancer)
What is the treatment for type 3 IF?
Home PN Intestinal transplantation- very specific cases as the long term survival is a bit lower then long term PN GLP2 treatment for short bowel treatment (new and only licensed in neonates- promising) Bowel lengthening (normally in children) Either STEP (transverse) or Bianchi (longitudinal).
How is home PN initiated?
Conversation with patient and relatives. Inpatient training with specialist nurse in aseptic technique for weeks- months.
GO home and have nurse check on them
What are the most common implications for home PN?
Non malignant GI problems
Cancer
CNS and mental health conditions
What is short bowel syndrome?
A small intestine <200cm long. Insufficient length of small bowel to meet nutritional needs.
Males often have a longer bowel than females
How long is the small bowel normally?
250-850cm
What length of bowel will definitely need home PN?
<50cm
What length of bowel will boarderline need home PN?
50cm + all of colon
100cm of small bowel
What is adaption of the bowel?
The body may slowly adapt to a smaller length of bowel
What salt solution is used in type 1 IF?
OGS- oral glucose saline. Its like dyoralyte
What is really important in nutrition and PN?
Documentation of discussions and decisions
Nutrition is a MD service. Who is part of the team
Doctor (gastroenterologist) Specialist nurse Dietitian Pharmacist Biochemist Ward round of inpatients and MDT every week
When is a small bowel transplantation considered?
Last resort. Usually combined with a liver transplant. DUe to liver disease or loss of venous access
50-60% 5 year survival and you may have a stoma but you are eating
What is a stoma?
an artificial opening made into a hollow organ, especially one on the surface of the body leading to the gut or trachea.
