Intestinal Failure

Question 1

what is intestinal failure

Answer 1

inability to maintain adequate nutrition or fluid status via intestines - requiring IV supplements
can be acute or chronic

Question 2

causes of intestinal failure

Answer 2

obstruction 
dysmotility 
surgical resection 
congenital defect
disease associated loss of absorption

Question 3

signs of intestinal failure

Answer 3

inability to maintain protein-energy, fluid, electrolyte or micronutrient balance

Question 4

acute short term intestinal failure

Answer 4

type 1 and 2;

Question 5

chronic long term intestinal failure

Answer 5

type 3;

Question 6

type 1 intestinal failure

Answer 6

short term

self-limiting intestinal failure

Question 7

type 2 inestinal failure

Answer 7

medium term

significant and prolonged practical nurse support

Question 8

type 3 intestinal failure

Answer 8

long term
chronic
long term practical nurse support

Question 9

causes of type 1 intestinal failure

Answer 9

surgical ileus 
critical illness
GI problems;
vomiting 
dysphagia 
pancreatitis 
GI obstruction 
diarrhoea 
oncology - chemo/DXT, GVHD

Question 10

causes of type 2 intestinal failure

Answer 10

post surgery awaiting reconstruction;
disaster 
Crohn's 
SMA
radiation 
adhesions 
fistulae

septic patients

Question 11

causes of type 3 intestinal failure

Answer 11

short bowel syndrome 
Crohn's +/- SBS
radiation +/- SBS
neoplasia 
dysmotility 
malabsorption - scleroderma, CV immunodeficiency 
inoperable obstruction - Ca2+

Question 12

treatment for type 1 intestinal failure

Answer 12

replace fluid and correct electrolytes 
parenteral nutrition (if unable to tolerate oral food)
proton pump inhibitors 
octreotide 
alpha hydroxycholecalciferol

Question 13

describe ocreotide

Answer 13

decreases the release of growth stimulating hormones
decreases blood flow to the digestive organs
inhibits the release of digestive hormones such as serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide.

Question 14

alpha hydroxycholecalciferol

Answer 14

a vitamin D compound
treats abnormalities in bone and mineral balance - preserves Mg
side effects on immune cells - T cells

Question 15

treatment for type 2 intestinal failure

Answer 15

weeks/months of care

parenteral feeding in hostpial

Question 16

treatment for type 3 intestinal failure

Answer 16

home parenteral nutrition - first line
intestinal transplantation
glucagon like peptide-2 (specific for short bowel syndrome)
bowel lengthening procedure

Question 17

describe short bowel syndrome

Answer 17

<200cm

unable to meet nutritional needs without artificial nutritional support

Question 18

groups of short bowel syndrome

Answer 18

small intestinal resections
massive intestinal resection
EC fistula
bypass surgery

Question 19

common causes of small intestinal resection - short bowel syndrome

Answer 19

Crohn’s

Question 20

common causes of massive intestinal resection - short bowel syndrome

Answer 20

infarction (SMA/SMV thrombosis)

Question 21

common causes of EC fistula - short bowel syndrome

Answer 21

high output

Question 22

uncommon causes of bypass surgery - short bowel syndrome

Answer 22

gastric bypass (obesity)

Question 23

types of short bowel syndrome

Answer 23

jejunostomy
ileostomy
jejuna-colic anastomosis
ileo-colic anastomosis

Question 24

long term nutrition and fluid provision for small bowel syndrome

Answer 24

dependent on the length of jejunum

Question 25

complications of parenteral nutrition with central venous access

Answer 25

pneumothorax
arterial puncture
misplacement

Question 26

complications of parenteral nutrition

Answer 26

Nutrient toxicity/insufficiency (e.g. Manganese)
Liver disturbance
Metabolic disturbance
Psycho-social
Inappropriate usage
Sepsis
SVC thrombosis
Line fracture
Line leakage
Line migration
Metabolic bone disease