Intestinal Failure

Question 1

what is it

Answer 1

the bodies nutritional needs can no longer be supported by gut due to reduced absorption

Question 2

what is type I (acute)

Answer 2

self limiting short term postoperative of paralytic ileus

Question 3

what is type II (acute)

Answer 3

prolonged, associated with sepsis and metabolic complications

Question 4

what is type III (chronic)

Answer 4

small bowel syndrome (small bowel <200)

Question 5

what is the cause

Answer 5

extensive surgery
obstruction (ischaemia)
malabsorption
congenital defects

Question 6

what is symptom

Answer 6

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

Question 7

how is it treated

Answer 7

decreased albumin (not reliable)
decreased vitamin and zinc

Question 8

how is type I treated

Answer 8

replace fluid
correct electrolytes
parenteral nutrition if unable to tolerate oral food/fluid >7 days post op
acid suppression by PPI (omeprazole, lansoprazole)
Octerotide (mimic natural somatostatin)
Alpha hydroxycholecalciferol to preserve Mg

Question 9

what are the complications of parenteral nutrition

Answer 9

pneumothorax
arterial puncture 
misplacement 
sepsis 
SVC
thrombosis 
metabolic bone disease
liver disease

Question 10

how is type II treated

Answer 10

weeks/months of care (ICU/HDU)

parenteral +/- some enteral feeding (NG or NJ tube)

Question 11

how is type III treated

Answer 11

home parenteral nutrition (treatment of choice)
intestinal transplant - last resort
GLP2 (teduglutie) treatment for SBS
bowel lengthening