Intestinal Failure

Question 1

What is intestinal failure?

Answer 1

inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance

Question 2

What can cause intestinal failure?

Answer 2

obstruction
dysmotility
surgical resection
congenital defect
disease associated loss of absorption

Question 3

Which types of intestinal failure are acute?

Answer 3

Type 1 and 2

Question 4

Which type of intestinal failure is chronic?

Answer 4

Type 3

Question 5

Describe Type 1?

Answer 5

Short term - days/weeks
Causes: surgical ileus, critical illness, GI problems (vomiting, dysphagia, pancreatitis, GI obstruction, Diarrheoa, Oncology)

Question 6

Describe Type 2?

Answer 6

Weeks/Months

Causes: post surgery awaiting reconstruction – crohns, SMA, radiation, adhesions, sepsis

Question 7

Describe Type 3?

Answer 7

Long term
Home Parenteral Nutrition needed
Intestinal Transplantation possible

Question 8

What is the treatment for Type 1?

Answer 8

-Replace fluid, correct electrolytes
–Parenteral Nutrition if unable to tolerate oral food/fluids > 7days post op
–Acid Suppression: proton pump inhibitors
–Octreotide
–Alpha hydroxycholecalciferol to preserve Mg
–Intensive multi-disciplinary input
–Allow some diet / enteral feeding

Question 9

What is the treatment for Type 2?

Answer 9

Parenteral +/- some enteral feeding

Question 10

What is Short Bowel Syndrome?

Answer 10

< 200 cm = Short Bowel Syndrome
once less than 50cm then they need to have parental feeding
Most common indication for Home Parental Nutrition

Question 11

Name some parental nutrition complications?

Answer 11

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