Intestinal Failure

Question 1

What is intestinal failure?

Answer 1

The inability to maintain adequate nutrition or fluid status via the intestines.

Question 2

What types of intestinal failure are acute and chronic?

Answer 2

Types 1 and 2 are acute, type 3 is chronic.

Question 3

Where is type 1 intestinal failure usually treated?

Answer 3

Wards.

Question 4

Where is type 2 intestinal failure usually treated?

Answer 4

HDU/ITU, then wards.

Question 5

Where is type 3 intestinal failure usually treated?

Answer 5

Wards then home.

Question 6

What are the potential causes of type 1 intestinal failure?

Answer 6

Surgical ileus, critial illness. GI problems: vomiting, dysphagia, pancreatitis, GI obstruction, diarrhoea, oncology, graft versus host disease.

Question 7

What are the potential causes of type 2 intestinal failure?

Answer 7

Post-surgery awaiting reconstruction, disaster (e.g. trauma or vascular event), Crohns, SMA, rediation, adhesions, fistula.

Question 8

What are the potential causes of type 3 intestinal failure?

Answer 8

Short bowel syndrome with maybe other pathology, Crohn’s, radiation, dysmotility, malabsorption (sleroderma, CVID), inoperable obstruction.

Question 9

What is the treatment for type 1 intestinal failure?

Answer 9

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.

Question 10

How long does type 2 IF usually need to be treated?

Answer 10

Weeks/months.

Question 11

What is the normal length of the small bowel?

Answer 11

250-850cm.

Question 12

What would be classified as a short bowel?

Answer 12

<200cm.

Question 13

What is the definition of short bowel syndrome?

Answer 13

Insufficient length of small bowel to meet nutritional needs without artificial nutritional support.

Question 14

When would you put someone with small bowel syndrome of home parenteral nutrition?

Answer 14

If they have less than 50cm of small bowel.

Question 15

When would it be borderline for people to be but on home parenteral nutrition?

Answer 15

If they have 50cm of small bowel and all of their large bowel.

Question 16

What are the surgical causes of SBS?

Answer 16

Small and massive intestinal resections, EC fistula (stoma).

Question 17

Give some examples of types of parenteral nutrition entry devices.

Answer 17

Peripheral (blue 22G PVC), central (PICC [peripherally inseted central catheter]).

Question 18

What type of catheter is used in parenteral nutrition?

Answer 18

Tunneled catheter.

Question 19

What are the complications of PN catheters?

Answer 19

Pneumothorax, arterial puncture, misplacement.

Question 20

Why is PN always given above the waist?

Answer 20

It prevents infection.

Question 21

What are the possible complications of PN in general?

Answer 21

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.

Question 22

What is a new and promising treatment for SBS?

Answer 22

GLP2 (teduglutide).

Question 23

What are the 2 types of bowel lengthening surgeries?

Answer 23

STEP or Bianchi.

Question 24

What are the required steps before home parenteral nutrition is given?

Answer 24

Documented IF assessed by a clinician with IF expertise before discussion with patient, transfer to GI ward, education and training (multi-disciplinary team).

Question 25

What professions make up the nutritional support team?

Answer 25

Dr, specialist nurse, dietician, pharmacist, biochemist.

Question 26

What surgery is small bowel transplantation usually combined with?

Answer 26

Liver transplantation.

Question 27

What are the main indications for small bowel transplantation?

Answer 27

Loss of venous access or liver disease.

Question 28

Will a patient with a small bowel transplant have a stoma?

Answer 28

Yes.