Intestinal Failure Flashcards
what is intestinal failure
inability to maintain adequate nutrition or fluid status via intestines - requiring IV supplements
can be acute or chronic
causes of intestinal failure
obstruction dysmotility surgical resection congenital defect disease associated loss of absorption
signs of intestinal failure
inability to maintain protein-energy, fluid, electrolyte or micronutrient balance
acute short term intestinal failure
type 1 and 2;
chronic long term intestinal failure
type 3;
type 1 intestinal failure
short term
self-limiting intestinal failure
type 2 inestinal failure
medium term
significant and prolonged practical nurse support
type 3 intestinal failure
long term
chronic
long term practical nurse support
causes of type 1 intestinal failure
surgical ileus critical illness GI problems; vomiting dysphagia pancreatitis GI obstruction diarrhoea oncology - chemo/DXT, GVHD
causes of type 2 intestinal failure
post surgery awaiting reconstruction; disaster Crohn's SMA radiation adhesions fistulae
septic patients
causes of type 3 intestinal failure
short bowel syndrome Crohn's +/- SBS radiation +/- SBS neoplasia dysmotility malabsorption - scleroderma, CV immunodeficiency inoperable obstruction - Ca2+
treatment for type 1 intestinal failure
replace fluid and correct electrolytes parenteral nutrition (if unable to tolerate oral food) proton pump inhibitors octreotide alpha hydroxycholecalciferol
describe ocreotide
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.
alpha hydroxycholecalciferol
a vitamin D compound
treats abnormalities in bone and mineral balance - preserves Mg
side effects on immune cells - T cells
treatment for type 2 intestinal failure
weeks/months of care
parenteral feeding in hostpial
treatment for type 3 intestinal failure
home parenteral nutrition - first line
intestinal transplantation
glucagon like peptide-2 (specific for short bowel syndrome)
bowel lengthening procedure
describe short bowel syndrome
<200cm
unable to meet nutritional needs without artificial nutritional support
groups of short bowel syndrome
small intestinal resections
massive intestinal resection
EC fistula
bypass surgery
common causes of small intestinal resection - short bowel syndrome
Crohn’s
common causes of massive intestinal resection - short bowel syndrome
infarction (SMA/SMV thrombosis)
common causes of EC fistula - short bowel syndrome
high output
uncommon causes of bypass surgery - short bowel syndrome
gastric bypass (obesity)
types of short bowel syndrome
jejunostomy
ileostomy
jejuna-colic anastomosis
ileo-colic anastomosis
long term nutrition and fluid provision for small bowel syndrome
dependent on the length of jejunum
complications of parenteral nutrition with central venous access
pneumothorax
arterial puncture
misplacement
complications of parenteral nutrition
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
