Intestinal Failure

Question 1

What is intestinal failure

Answer 1

Inability to maintain adequate nutrition or fluid status via the intestines

Question 2

Aetiology

Answer 2

Obstruction, dysmotility, surgical resection, congenital defects or disease with loss of absorption

Question 3

Types of intestinal failure

Answer 3

Type 1 - Self limiting, short term postoperative or paralytic ileus
Type 2 - Prolonged, associated with spesis and metabolic complications. Often due to abdominal surgery with complications
Type 3 - Long term but stable, home parental nutrition

Question 4

What type of intestinal failure is classified as acute

Answer 4

Type 1 and 2

Question 5

What is Ileus

Answer 5

Lack of movement in the intestines that leads to a buildup and potential blockage of food material

Question 6

Treatment of Type 1 intestinal failure

Answer 6

Replace fluid/electrolytes
If can’t tolerate oral food/fluids then parenteral nutrition
Inhibit HCl secretion via proton pump inhibitors or Octreotide
Alpha hydroxycholecalciferol to preserve Mg

Question 7

What is Octreotide

Answer 7

Pharmacologically similar to Somatostatin; this drug inihibits hormones such as Gastrin, Secretin and CCK resulting in inhibition of HCl from parietal cells

Question 8

How is venous access sought for parenteral nutrition

Answer 8

Peripherally inserted central catheter (PICC) line -
Enters SVC, inserted in vein of arm.
Hickman Line - Similiar to PICC but enters Jugular vein
Both can stay in body for days to weeks

Question 9

Complications of central venous access

Answer 9

Pneumothorax, arterial puncture, misplacement

Question 10

Patients with sepsis or abdominal fistulae present with what type of intestinal failure

Answer 10

Type 2, weeks - months of care

Question 11

Management of choice for chronic intestinal failure

Answer 11

Home parenteral nutrition

Question 12

What is dysmotility

Answer 12

Condition in which muscles of digestive system become impaired and changes in speed, strength and coordination occurs

Question 13

What is short bowel syndrome

Answer 13

Length of small intestines < 300 cm

Question 14

Consequence of short bowel syndrome

Answer 14

Insufficient length of small bowel to meet nutritional needs without artificial nutritional support

Question 15

What nutrition for jejunum length 101-150 cm after jejunostomy

Answer 15

Oral/enteral oral glucose/saline solution (OGS)

Question 16

What nutrition for jejunum 0-100 cm after jejunostomy

Answer 16

0 - 50; Parenteral with saline fluid

51 - 100; Parenteral with saline fluid

Question 17

What treatment in short bowel syndrome is practised on children but not validated in adults

Answer 17

Bowel lengthening -
Longitudinal lengthening (Bianchi procedure)
Serial Transverse Enteroplasty (STEP)

Question 18

Treatment of choice for Type 3 intestinal failure

Answer 18

Home parenteral nutrition

Question 19

Last resort treatment for intestinal failure

Answer 19

Small bowel transplantation, usually combined with liver transplant

Question 20

Main indications for small intestine transplant

Answer 20

Loss of venous access and/or liver disease

Question 21

Small intestine transplant drawbacks

Answer 21

Stoma remains and high morbidity/mortality

50-60% 5 year survival

Question 22

What is the Malnutrition Universal Screening Tool

Answer 22

MUST is a five step screening tool to identify adults who are malnourished, risk of malnutrition (undernourished) or obese. Also has guidelines to develop a care plan

Question 23

What can be used to identify nutritional needs

Answer 23

MUST screening tool