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Flashcards in Intestinal failure Deck (34)
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1
Q

What is intestinal failure?

A

The inability to maintain adequate nutrition or fluid status via the intestines resulting in a need for IV supplementation through PE nutrition

2
Q

What are the characteristics of intestinal failure?

A

Micronutrient , fluid, electrolyte imbalance,malabsorptions and lack of energy

3
Q

You can get acute and chronic intestinal failure. What types come under which heading?

A
Acute = type 1 and 2 
Chronic = type 3
4
Q

What is type 1 IF?

A

Self limiting short term postoperative or paralytic ileus. Cared for on the ward

5
Q

What is type 2 IF?

A

Prolonged, associated with sepsis and metabolic complication or abdominal surgery with complications. Cared for on HDU or ITC

6
Q

What is type 3 Intestinal failure?

A

Long term but stable. Home parentral nutrition often indicated

7
Q

What causes Type 1 IF?

A

Sepsis, GI problems with vomiting, dysphagia, pancreatistsi, obstruction, oncology (following chemo or radio therapy

8
Q

How is type 1 IF treated?

A

Normally occurs in previously healthy individuals.
Replace fluid lost and correct electrolytes. PN if unable to tolerate food/fluids after 7 days
PPI, Octreotide, Alpha hydroxycholecalciferol

9
Q

What is PPI used for in IF?

A

To reduce gastric secretions

10
Q

What is Octreotide used for in IF?

A

Suppress pancreatic secretions

11
Q

What is Alpha hydroxycholeciferol used for in IF?

A

Preserve Magnisium

12
Q

What types of venous access can be used to give PN?

A
Blue PVC
PICC line (peripherally inserted central catherter) up to 14 days
Hickmann line (tunneled catheter)
Vascuport (good for home PN)
Often inserted with ultrasound guidance
13
Q

What are the complications with establishing vascular access for PN?

A

Pneumothorax Arterial puncture or misplacement

14
Q

WHy would you never give PN through veins below the waist?

A

Much greater risk of infection- you are essentially giving lots of glucose

15
Q

Which vein is often used for PN?

A

Subclavian veins

16
Q

What are the complications of PN?

A
Sepsis
SVC thrombosis
Line fracture/leakage/migration
Metabolic bone disease
Nutrient toxicity/insufficiency
Liver disease (monitor liver function)
Metabolic disturbance
PSYCHOSOCIAL
Inappropriate usage
17
Q

What are the causes of type 2 intestinal failure?

A
Surgical complications (most common)
Sepsis
Abdominal fistula (crohn's),
 trauma or vascular event, 
SMA (superior mesenteric artery syndrome),
Malignancy
18
Q

What is superior mesenteric syndrome?

A

third and final portion of the duodenum is compressed between the abdominal aorta (AA) and the overlying superior mesenteric artery.

19
Q

What is the treatment for Type 2 IF?

A

PN +/- some entral feeding and trying to wean them off it slowly.

20
Q

What foods should people begin with when coming off PN?

A

Clear soups and fluids, jellys and high calorie supplementation drinks

21
Q

What are the causes of type 3 IF?

A

Short Bowel syndrome (most common)

Crohns, malabsorption, dysmotility, inoperable Ca, Radiation (prostate/ovarian cancer)

22
Q

What is the treatment for type 3 IF?

A
Home PN
Intestinal transplantation- very specific cases as the long term survival is a bit lower then long term PN
GLP2 treatment for short bowel treatment (new and only licensed in neonates- promising)
Bowel lengthening (normally in children) Either STEP (transverse) or Bianchi (longitudinal).
23
Q

How is home PN initiated?

A

Conversation with patient and relatives. Inpatient training with specialist nurse in aseptic technique for weeks- months.
GO home and have nurse check on them

24
Q

What are the most common implications for home PN?

A

Non malignant GI problems
Cancer
CNS and mental health conditions

25
Q

What is short bowel syndrome?

A

A small intestine <200cm long. Insufficient length of small bowel to meet nutritional needs.
Males often have a longer bowel than females

26
Q

How long is the small bowel normally?

A

250-850cm

27
Q

What length of bowel will definitely need home PN?

A

<50cm

28
Q

What length of bowel will boarderline need home PN?

A

50cm + all of colon

100cm of small bowel

29
Q

What is adaption of the bowel?

A

The body may slowly adapt to a smaller length of bowel

30
Q

What salt solution is used in type 1 IF?

A

OGS- oral glucose saline. Its like dyoralyte

31
Q

What is really important in nutrition and PN?

A

Documentation of discussions and decisions

32
Q

Nutrition is a MD service. Who is part of the team

A
Doctor (gastroenterologist)
Specialist nurse
Dietitian
Pharmacist
Biochemist 
Ward round of inpatients and MDT every week
33
Q

When is a small bowel transplantation considered?

A

Last resort. Usually combined with a liver transplant. DUe to liver disease or loss of venous access
50-60% 5 year survival and you may have a stoma but you are eating

34
Q

What is a stoma?

A

an artificial opening made into a hollow organ, especially one on the surface of the body leading to the gut or trachea.