Intestinal Failure Flashcards
What is intestinal failure?
The inability to maintain adequate nutrition or fluid status via the intestines.
What types of intestinal failure are acute and chronic?
Types 1 and 2 are acute, type 3 is chronic.
Where is type 1 intestinal failure usually treated?
Wards.
Where is type 2 intestinal failure usually treated?
HDU/ITU, then wards.
Where is type 3 intestinal failure usually treated?
Wards then home.
What are the potential causes of type 1 intestinal failure?
Surgical ileus, critial illness. GI problems: vomiting, dysphagia, pancreatitis, GI obstruction, diarrhoea, oncology, graft versus host disease.
What are the potential causes of type 2 intestinal failure?
Post-surgery awaiting reconstruction, disaster (e.g. trauma or vascular event), Crohns, SMA, rediation, adhesions, fistula.
What are the potential causes of type 3 intestinal failure?
Short bowel syndrome with maybe other pathology, Crohn’s, radiation, dysmotility, malabsorption (sleroderma, CVID), inoperable obstruction.
What is the treatment for type 1 intestinal failure?
Replace fluid and correct electrolytes, parenteral nutrition if unable to tolerate food/fluids more than 7 days post op, proton pump inhibitors, octreotide, alpha hydroxycholecalciferol to preserve Mg, allow some enteral feeding.
How long does type 2 IF usually need to be treated?
Weeks/months.
What is the normal length of the small bowel?
250-850cm.
What would be classified as a short bowel?
<200cm.
What is the definition of short bowel syndrome?
Insufficient length of small bowel to meet nutritional needs without artificial nutritional support.
When would you put someone with small bowel syndrome of home parenteral nutrition?
If they have less than 50cm of small bowel.
When would it be borderline for people to be but on home parenteral nutrition?
If they have 50cm of small bowel and all of their large bowel.
What are the surgical causes of SBS?
Small and massive intestinal resections, EC fistula (stoma).
Give some examples of types of parenteral nutrition entry devices.
Peripheral (blue 22G PVC), central (PICC [peripherally inseted central catheter]).
What type of catheter is used in parenteral nutrition?
Tunneled catheter.
What are the complications of PN catheters?
Pneumothorax, arterial puncture, misplacement.
Why is PN always given above the waist?
It prevents infection.
What are the possible complications of PN in general?
Sepsis, SVC thrombosis, line fracture, line leakage, line migration, metabolic bone disease, nutrient toxicity/insufficiency e.g. Manganese, liver disturbance, metabolic disturbance, psycho-social, inapproprate usage.
What is a new and promising treatment for SBS?
GLP2 (teduglutide).
What are the 2 types of bowel lengthening surgeries?
STEP or Bianchi.
What are the required steps before home parenteral nutrition is given?
Documented IF assessed by a clinician with IF expertise before discussion with patient, transfer to GI ward, education and training (multi-disciplinary team).
What professions make up the nutritional support team?
Dr, specialist nurse, dietician, pharmacist, biochemist.
What surgery is small bowel transplantation usually combined with?
Liver transplantation.
What are the main indications for small bowel transplantation?
Loss of venous access or liver disease.
Will a patient with a small bowel transplant have a stoma?
Yes.
