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Y4 Gastrointestinal > Intestinal failure (pie) > Flashcards

Intestinal failure (pie) Flashcards

1
Q

Define what intestinal failure is

A
  • It is the reduction in function of the intestines below the minimum necessary for the absorption of macronutrients and / or water and electrolytes such that intravenous supplementation is required to maintain health and / or growth.
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2
Q

What are the 3 main types of intestinal failure (IF) ?

A
  • Type 1 - Self-limiting lasting days/weeks
  • Type 2 - IF requiring Significant & prolonged PN support (>28 days)
  • Type 3 - Chronic IF requiring long term PN support
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3
Q

List the different causes of IF

A
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4
Q

What is the management of type 1 IF ?

A
  • Replace fluid, correct electrolytes
  • Acid Suppression: proton pump inhibitors
  • Anti-diarrhoeal - coedine sulphate or loperamide 1st line, 2nd line = Octreotide
  • Alpha hydroxycholecalciferol to preserve Mg
  • Allow some diet / enteral feeding
  • Parenteral Nutrition if unable to tolerate oral food/fluids > 7days post op
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5
Q

What is the management of type 2 IF ?

A
  • Weeks/months of care (ICU/HDU)
  • Parenteral +/- some enteral feeding (feeding through GI tract)
  • Replace fluid, correct electrolytes
  • Acid Suppression: proton pump inhibitors
  • Octreotide
  • Alpha hydroxycholecalciferol to preserve Mg

Basically the same as for type 1 IF expect prolonged and more relient on PN nutrition

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6
Q

What is the management of type 3 IF ?

A

Home Parenteral Nutrition is the treatment of choice

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7
Q

Define what short bowel syndrome is ?

A

Insufficient length of small bowel to meet nutritional needs without artificial nutritional support. <200cm of bowel results in short bowel sydrome, with < 50cm usually requiring entirly PN nutrition

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8
Q

What is the most common cause of type 3 IF ?

A

Short bowel syndrome

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9
Q

What are the causes of short bowel syndrome ?

A
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10
Q

Define what parenteral nutrition (PN) is

A

The administration of nutrient solutions via a central or peripheral vein

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11
Q

What are the ways in which PN nutrition can be given ?

A
  • Peripheral via a Blue 22G PVC
  • Central via a PICC (peripherally inserted central catheter) 14 days or Tunnelled catheter (Hickman line)
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12
Q

What are the potential complications of PN nutrition ?

A
  • Sepsis
  • SVC thrombosis
  • Line fracture
  • Line leakage
  • Line migration
  • Metabolic bone disease
  • Nutrient toxicity/insufficiency e.g. Manganese
  • Liver disturbance
  • Metabolic disturbance
  • Psycho-social
  • Inappropriate usage
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13
Q

What is the 2nd line option for treatment of type 3 IF and what are the main indications for its use ?

A
  • Small bowel transplantation (usually liver transplant done as well)
  • Usually as a last resort when there is loss of venous access/liver disease
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14
Q

Define what malnutrition is

A

A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form (body shape, size and composition), function and clinical outcome.

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15
Q

What are the causes of malnutrition ?

A
  1. Decreased intake – poor appetite, pain on eating, medication side effects, dysphagia, sore mouth
  2. Impaired digestion and or absorption commonly coeliacs disease, crohns disease, post infectious, biliary obstruction, cirrhosis, short bowel syndrome etc
  3. Increased requirements – catabolism infection, trauma, burns, surgery
  4. Increased losses – vomiting, diarrhoea, stoma losses
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16
Q

What are the effects of malnutrition ?

A
17
Q

What screening tool is used to identify people who are malnourished, at risk of malnutrition or obese ?

A

MUST screening tool

18
Q

What are the different methods of nutritional support which can be given to someone ?

A
  1. Food fortification & dietary counselling
  2. Oral nutrition support – e.g. additional snacks and/or sip feeds
  3. Enteral tube feeding – the delivery of a nutritionally complete feed directly into the gut via a tube
  4. Parenteral nutrition – the delivery of nutrition intravenously

Or a combination

19
Q

Who needs nutritional support ?

A
  • BMI <18.5
  • Unintentional weight loss >10% within the last 3–6 months
  • BMI <20 and unintentional weight loss >5% within the last 3–6 months
  • Have eaten or are likely to eat little or nothing for more than 5 days or longer
  • Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism
20
Q

What is the 1st step in managing malnutrition ?

A

Dietry advice, food fortification - this includes fortifying foods e.g. adding in milks and cheeses to increase calorie and fat intake, nutritional supplements, adding in snacks etc

21
Q

Give some examples of nutritional supplements

A
22
Q

Define what enternal tube feeding (ETF) is

A

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum via:

  • Nasogastric (NG)
  • Nasojejunal (NJ)
  • Percutaneous endoscopic gastrostomy PEG
  • Percutaneous jejunostomy
  • Surgical jejunostomy
23
Q

What are the indications for ETF ?

A

Inadequate or unsafe oral intake, and a functional, accessible gastrointestinal tract ‘if the gut works, use it’ e.g:

  • Unconscious patients
  • Neuromuscular swallowing disorder
  • Upper GI obstruction
  • GI dysfunction
  • Increased nutritional requirements
24
Q

What are the contraindications to ETF ?

A
  • Lower gastrointestinal obstruction
  • Prolonged intestinal ileus
  • Severe diarrhoea or vomiting
  • High enterocutaneous fistula
  • Intestinal ischaemia

An enterocutaneous fistula (ECF) is an abnormal connection that develops between the intestinal tract or stomach and the skin. As a result, contents of the stomach or intestines leak through to the skin.

25
Q

What are the potential complications of ETF?

A
26
Q

What is refeeding syndrome ?

A

Refeeding syndrome describes the metabolic abnormalities which occur on feeding a person following a period of starvation. It occurs when an extended period of catabolism ends abruptly with switching to carbohydrate metabolism.

27
Q

What are the metabolic features of refeeding syndrome ?

A
  • Hypokalaemia
  • Hypophosphataemia
  • Hypomagnesaemia
  • Altered glucose metabolism
  • Fluid overload
28
Q

What are the complications which may be seen of refeeding syndrome ?

A
  • Arrhythmias
  • Altered level of consciousness
  • Seizure
  • Respiratory failure
  • Cardiovascular collapse
  • Death
29
Q

Who is at risk of refeeding syndrome ?

A
30
Q

How is refeeding syndrome prevented in moderate risk patients ?

A
31
Q

How is refeeding syndrome prevented in high risk patients ?

A
  • Start at up to 10 kcal/kg/day increasing to full needs over 4-7 days
  • Start immediately before and during feeding: oral thiamine 200-300mg/day, vitamin B co strong 1 tds and supplements
  • Give K+ (2-4 mmol/kg/day), phosphate (0.3-0.6 mmol/kg/day), magnesium (0.2-0.4 mmol/kg/day)

Y4 Gastrointestinal (28 decks)

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