wk 2 4 intestinal failure Flashcards
define intestinal failure
inability to maintain adequate nutruition or fluid status
what ca cause IF
obstruction dysmotility surgical resection congenital defect disease
characteristics of IF
inability to maintain protein-energy
fluid
electrolyte
micronutrient balance
example of acute IF
mucositis
post chemo
IF can be divided into 3 types
1 - self-limiting short term, post-op, paralytic ileus
2-prolonged,associatd with sepsis/metabolic coomplications. (surgery)
3-long term but stable, home parenteral nutrition
parenteral
nutruition delivery via IV
surgical ileus
stopping of peristalsis post-op
associated GI problems of IF type 1
vomiting dysphagia pancreatitis obstruction diarrhoea oncology - chemo, bone marrow transplant
asssociated conditions of type 2 IF
(post-op usually) trauma chrons SMA radiation adhesions- inflammatory fistulae (part of Chrons)
associated conditions with type 3
short bowel syndrome chrons +/-SBS Radiation +/- SBS dysmotility malabsorption Inoperable obstruction
when would parenteral nutrition be considred for ttype 1
after a week
treatment for type 1
acid suppressioin: proton pump inhibitors
octreotide
alpha hydroxycholecalciferol
diet/enteral feeding
define short bowel syndrome
insufficient length of small bowel to meet nutritional needs without artifical nutritional support
circumstances when parenteral nutrition is not required for type 3
over time adaptation occurs
if small bowel about 50 and long colon
what would be given if patient has <50cm/51-100/101-150
0-50 -parenteral saline/nutrition
51-100 parenteral saline nutrition-oral/enteral
101-150 oral/enteral OGs (Oral glucose saline) nutrition - none
PN therapy is dependent on
type of venous access
peripheral/central
associated complications of central PN
pneumothorax -if close to neck/lungs
arterial occlusion
infection
central venous catheter can be seen with the naked eye t/f
true
little bump, subclavian or neck
why PN is never given through groin vessels
nutrient rich medium, if near groin incr chance of developing infections
PN complications
sepsis SVC thrombosis if line requires changing endocarditis line fracture line leakage line migration electrolyte disturbance
other than home PN for type 3, what other treatments are ther
intestinal transplantation
glucagon-like peptide-2 (teduglutide) treatment
(currently only for neonates)
bowel lengthening
main indications for small bowel transplantation
loss of venous access
liver disease developing
