Intestinal Failure Flashcards
what is the definition of intestinal failure
the reduction below the minimum necessary for the absorption of macronutrients and or water and electrolytes such that IV supplementation is required to maintain health and growth
what can intestinal failure be caused by
obstruction, dysmotility, surgical resection, congenital defect, disease associated with loss of absorption
what is intestinal failure characterised by
the inability to maintain protein-energy, fluid, electrolyte or micronutrient balance
what is acute intestinal failure and give an example
short term, 2 weeks e.g. mucositis post chemotherapy
type 1 and 2
what is acute intestinal failure and give an example
long term, e.g. short gut syndrome
type 3 only
what is type 1 intestinal failure
self limiting short term post operative or paralytic ileus
what is an ileus
Ileus is the medical term for this lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material
what is type 2 intestinal failure
prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications
what is type 3 intestinal failure
long term but stable- home parental nutrition often indicated
what can cause type 1 intestinal failure
surgical ileus, critical illness, GI problems (vomiting, dysphagia, pancreatitis, GI obstruction, diarrhoea, oncology (chemo/ DXT, graft virus host disease))
how do you treat someone with type 1 intestinal failure who is normal or moderately malnourished
replace fluid, correct electrolytes
PN if cant tolerate oral foods/fluids >7 days post op
acid suppression (proton pump inhibitors)
octreotide
alpha hydroxycholecalciferol to preserve Mg
intensive multi-disciplinary unit input
allow some diet/ enteral feeding
what are the complications of central parenteral nutrition
pneumothorax/ arterial puncture/ misplacement
what are the types of PN
depends on venous access:
- peripheral
- central
why do you never give PN through femoral groins
as increased chance of developing infections (as nutrient rich substance)
what are the complications of PN
sepsis, endocarditis, SVC thrombosis, line fracture/migration/leakage, metabolic bone disease, nutrient toxicity/ insufficiency, liver disease, metabolic disturbance, psycho-social, inappropriate usage
what type of patients can commonly get type 2 IF
septic patients
what can cause type 2 IF
post surgery awaiting reconstruction:
- disaster (trauma)
- crohns
- SMA (superior mesenteric artery syndrome)
- radiation
- adhesions
- fistulae
how is type 2 IF treated
weeks/ months of care (ICU/HDU)
parenteral +/- some enternal feeding
what can cause type 3 IF
-short bowl syndrome (+/- pathology)
-crohns (+/- SBS
-radiation (+/-SBS)
-dysmobility
-malabsorption
(scleroderma, CV immunodef)
-inoperable obstruction
how do you treat type 3 IF
- home PN
- intestinal transplantation
- GLP2 treatment for SBS
- bowel lengthening
what causes of type 3 IF need home PN
Short gut syndrome Crohn’s disease Neoplasia Vascular Mechanical Radiation enteritis Dysmotility
what is classified as a short bowl
<200cm
what is short bowl syndrome
insufficient length of bowl to meet nutritional needs without nutritional support
what is a common and two uncommon causes of small intestinal resection
common- crohns disease
uncommon- post irradiation enteritis, repeated surgery for surgical complications
what are the common and uncommon cause of massive intestinal resection
common- infarction
uncommon- SMA embolus, massive volvulus, desmoid tumour
what can cause an EC fistula (enterocutaneuous)
high output
what can cause a bypass surgery
gastric bypass (obesity)
what are the types of short bowl syndrome
jejunostomy, ileostomy, jejuno-colic anastamosis, ileo- colic anastomoses
what is the multidisciplinary team supporting a patient with SBS
medical, dietetics, pharmacy, nursing, catering
what are the main indicators for small bowl transplantation
last resort
loss of venous access/ liver disease
(usually combined with liver transplant)
