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GI > Intestinal Failure > Flashcards

Intestinal Failure Flashcards

1
Q

What is the definition of intestinal failure?

A
  • inability to maintain adequate nutrition or fluid status via the intestines
    => Pt can’t maintain protein-energy, fluid, electrolyte, or micronutrient balance
  • Need IV supplementation to maintain health/ growth
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2
Q

What are the potential causes of intestinal failure?

A
  • obstruction
  • dysmotility
  • surgical resection
  • congenital defect
  • disease associated loss of absorption
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3
Q

Describe the difference in time frame between acute and chronic intestinal failure

A 
ACUTE = 2 weeks
CHRONIC = long term (e.g. due to short gut syndrome)
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4
Q

There are 3 main types of intestinal failure. Which of these are acute and which are chronic?

A

Types 1+2 = ACUTE

Type 3 = CHRONIC

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5
Q

What is the difference between Type 1 and 2 intestinal failure?

A

Type 1 = self limiting

Type 2 = significant and prolonged >28 days (requiring parenteral nutrition support)

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6
Q

What can cause Type 1 intestinal failure?

A
  • Surgical ileus

GI problems:

  • Vomiting
  • Dysphagia
  • Pancreatitis
  • obstruction
  • Diarrheoa
  • Oncology/Chemo/
  • Graft Vs Host Disease
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7
Q

What can cause Type 2 Intestinal failure?

A

Post surgery awaiting reconstruction:

  • Crohns
  • SMA
  • Radiation
  • Adhesions
  • Fistulae
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8
Q

What can cause Type 3 Intestinal failure?

A
  • Short Bowel syndrome
  • Crohns (+/-SBS)
  • Radiation (+/-SBS)
  • Dysmotility
  • Malabsorption
  • Scleroderma
  • Inoperable obstruction (e.g. Cancer)
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9
Q

How is Type 1 intestinal failure treated?

A
  • Replace fluid + electrolytes
  • Parenteral Nutrition if unable to tolerate oral food/fluids
  • Acid Suppression: PPIs
  • Octreotide
  • Alpha hydroxycholecalciferol to preserve Mg2+
  • Allow some diet / enteral feeding
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10
Q

Where are Type 2 IF patients usually treated?

A
  • Weeks/months of care in ICU/HDU

- Parenteral +/- some enteral feeding

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11
Q

What is the management of choice for chronic IF?

A

Home parenteral nutrition

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12
Q

How long is the small bowel normally and what does this reduce to in short bowel syndrome?

A

Normal = 250 – 1050 cm
(Males longer than females)

< 200 cm = Short Bowel

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13
Q

Below what length of small bowel is an indication for home parenteral nutrition?

A

< 50 cm of small bowel

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14
Q

What can cause patients to have many small sections of bowel removed that eventually results in short bowel syndrome?

A
  • Crohn’s disease (COMMON)

(UNCOMMON)

  • post irradiation enteritis
  • repeated surgery for surgical complications
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15
Q

What can cause patients to need a massive resection of bowel that results in short gut syndrome?

A
  • SMA/SMV infarction
  • SMA embolus
  • volvulus
  • desmoid tumour
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16
Q

WHat different types of short bowel exist (due to previous surgical procedures)?

A
  • Jejunostomy
  • Ileostomy
  • Jejuno- colic anastamosis
  • Ileo- colic anastamosis
17
Q

What fluids are used in patients with shorter lengths of bowel, (50-100cm), compared to those with up to 200cm of bowel?

A
  • Saline used for shorter bowel

- Oral glucose/saline solution (OGS) used at longer bowel lengths

18
Q

What different types of venous access can be used to deliver parenteral nutrition?

A
  • Peripheral venous catheter
  • Central Line
    => PICC (peripherally inserted central catheter)
    => Tunnelled catheter (Hickman line)
    => Vascuport
19
Q

What are the potential complications of parenteral nutrition?

A
  • Sepsis
  • SVC thrombosis
  • Line fracture/ leakage/ migration
  • Metabolic bone disease
  • Nutrient toxicity/insufficiency e.g. Manganese
  • Liver disturbance
20
Q

The long term survival of intestinal transplantation in CHRONIC IF is lower than those who receive home parenteral nutrition. TRUE/FALSE?

A

TRUE

21
Q

What expensive treatment can be used for patients with Short Bowel Syndrome?

A

Glucagon Like Pepetide-2 (teduglutide)

22
Q

What surgical procedures can be used to lengthen shortened bowel?

A

Bianchi procedure (longitudinal lengthening)

Serial Transverse Enteroplasty (STEP)

23
Q

Who is involved in a patient’s nutritional support team if they are on home parenteral nutrition?

A 
Dr (gastroenterologist, surgeon)
Specialist Nurse
Dietitian
Pharmacist
Biochemist
24
Q

Small bowel transplantation is usually combined with which other organ transplant?

A

Liver

25
Q

What are the main indications for a Liver and Small Bowel transplant?

A
  • Loss of venous access

- Liver disease

GI (33 decks)

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