Intestinal Failure Flashcards
What is intestinal failure
Inability to maintain adequate nutrition or fluid status via the intestines
Aetiology
Obstruction, dysmotility, surgical resection, congenital defects or disease with loss of absorption
Types of intestinal failure
Type 1 - Self limiting, short term postoperative or paralytic ileus
Type 2 - Prolonged, associated with spesis and metabolic complications. Often due to abdominal surgery with complications
Type 3 - Long term but stable, home parental nutrition
What type of intestinal failure is classified as acute
Type 1 and 2
What is Ileus
Lack of movement in the intestines that leads to a buildup and potential blockage of food material
Treatment of Type 1 intestinal failure
Replace fluid/electrolytes
If can’t tolerate oral food/fluids then parenteral nutrition
Inhibit HCl secretion via proton pump inhibitors or Octreotide
Alpha hydroxycholecalciferol to preserve Mg
What is Octreotide
Pharmacologically similar to Somatostatin; this drug inihibits hormones such as Gastrin, Secretin and CCK resulting in inhibition of HCl from parietal cells
How is venous access sought for parenteral nutrition
Peripherally inserted central catheter (PICC) line -
Enters SVC, inserted in vein of arm.
Hickman Line - Similiar to PICC but enters Jugular vein
Both can stay in body for days to weeks
Complications of central venous access
Pneumothorax, arterial puncture, misplacement
Patients with sepsis or abdominal fistulae present with what type of intestinal failure
Type 2, weeks - months of care
Management of choice for chronic intestinal failure
Home parenteral nutrition
What is dysmotility
Condition in which muscles of digestive system become impaired and changes in speed, strength and coordination occurs
What is short bowel syndrome
Length of small intestines < 300 cm
Consequence of short bowel syndrome
Insufficient length of small bowel to meet nutritional needs without artificial nutritional support
What nutrition for jejunum length 101-150 cm after jejunostomy
Oral/enteral oral glucose/saline solution (OGS)
What nutrition for jejunum 0-100 cm after jejunostomy
0 - 50; Parenteral with saline fluid
51 - 100; Parenteral with saline fluid
What treatment in short bowel syndrome is practised on children but not validated in adults
Bowel lengthening -
Longitudinal lengthening (Bianchi procedure)
Serial Transverse Enteroplasty (STEP)
Treatment of choice for Type 3 intestinal failure
Home parenteral nutrition
Last resort treatment for intestinal failure
Small bowel transplantation, usually combined with liver transplant
Main indications for small intestine transplant
Loss of venous access and/or liver disease
Small intestine transplant drawbacks
Stoma remains and high morbidity/mortality
50-60% 5 year survival
What is the Malnutrition Universal Screening Tool
MUST is a five step screening tool to identify adults who are malnourished, risk of malnutrition (undernourished) or obese. Also has guidelines to develop a care plan
What can be used to identify nutritional needs
MUST screening tool
