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GI > Intestinal Failure > Flashcards

Intestinal Failure Flashcards

1
Q

what is the definition of intestinal failure

A

the reduction below the minimum necessary for the absorption of macronutrients and or water and electrolytes such that IV supplementation is required to maintain health and growth

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2
Q

what can intestinal failure be caused by

A

obstruction, dysmotility, surgical resection, congenital defect, disease associated with loss of absorption

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3
Q

what is intestinal failure characterised by

A

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

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4
Q

what is acute intestinal failure and give an example

A

short term, 2 weeks e.g. mucositis post chemotherapy

type 1 and 2

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5
Q

what is acute intestinal failure and give an example

A

long term, e.g. short gut syndrome

type 3 only

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6
Q

what is type 1 intestinal failure

A

self limiting short term post operative or paralytic ileus

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7
Q

what is an ileus

A

Ileus is the medical term for this lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material

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8
Q

what is type 2 intestinal failure

A

prolonged, associated with sepsis and metabolic complications. Often related to abdominal surgery with complications

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9
Q

what is type 3 intestinal failure

A

long term but stable- home parental nutrition often indicated

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10
Q

what can cause type 1 intestinal failure

A

surgical ileus, critical illness, GI problems (vomiting, dysphagia, pancreatitis, GI obstruction, diarrhoea, oncology (chemo/ DXT, graft virus host disease))

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11
Q

how do you treat someone with type 1 intestinal failure who is normal or moderately malnourished

A

replace fluid, correct electrolytes

PN if cant tolerate oral foods/fluids >7 days post op

acid suppression (proton pump inhibitors)

octreotide

alpha hydroxycholecalciferol to preserve Mg

intensive multi-disciplinary unit input

allow some diet/ enteral feeding

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12
Q

what are the complications of central parenteral nutrition

A

pneumothorax/ arterial puncture/ misplacement

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13
Q

what are the types of PN

A

depends on venous access:

  • peripheral
  • central
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14
Q

why do you never give PN through femoral groins

A

as increased chance of developing infections (as nutrient rich substance)

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15
Q

what are the complications of PN

A

sepsis, endocarditis, SVC thrombosis, line fracture/migration/leakage, metabolic bone disease, nutrient toxicity/ insufficiency, liver disease, metabolic disturbance, psycho-social, inappropriate usage

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16
Q

what type of patients can commonly get type 2 IF

A

septic patients

17
Q

what can cause type 2 IF

A

post surgery awaiting reconstruction:

  • disaster (trauma)
  • crohns
  • SMA (superior mesenteric artery syndrome)
  • radiation
  • adhesions
  • fistulae
18
Q

how is type 2 IF treated

A

weeks/ months of care (ICU/HDU)

parenteral +/- some enternal feeding

19
Q

what can cause type 3 IF

A

-short bowl syndrome (+/- pathology)
-crohns (+/- SBS
-radiation (+/-SBS)
-dysmobility
-malabsorption
(scleroderma, CV immunodef)
-inoperable obstruction

20
Q

how do you treat type 3 IF

A
  • home PN
  • intestinal transplantation
  • GLP2 treatment for SBS
  • bowel lengthening
21
Q

what causes of type 3 IF need home PN

A 
Short gut syndrome 
Crohn’s disease
Neoplasia
Vascular
Mechanical
Radiation enteritis
Dysmotility
22
Q

what is classified as a short bowl

A

<200cm

23
Q

what is short bowl syndrome

A

insufficient length of bowl to meet nutritional needs without nutritional support

24
Q

what is a common and two uncommon causes of small intestinal resection

A

common- crohns disease

uncommon- post irradiation enteritis, repeated surgery for surgical complications

25
Q

what are the common and uncommon cause of massive intestinal resection

A

common- infarction

uncommon- SMA embolus, massive volvulus, desmoid tumour

26
Q

what can cause an EC fistula (enterocutaneuous)

A

high output

27
Q

what can cause a bypass surgery

A

gastric bypass (obesity)

28
Q

what are the types of short bowl syndrome

A

jejunostomy, ileostomy, jejuno-colic anastamosis, ileo- colic anastomoses

29
Q

what is the multidisciplinary team supporting a patient with SBS

A

medical, dietetics, pharmacy, nursing, catering

30
Q

what are the main indicators for small bowl transplantation

A

last resort
loss of venous access/ liver disease
(usually combined with liver transplant)

GI (64 decks)

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