Intestinal Failure

Question 1

Define intestinal failure.

Answer 1

Inability to maintain adequate nutrition or fluid status via intestines.

Inability to maintain protein, electrolyte, fluid, micronutrient levels

Question 2

List some reasons that might cause intestinal failure

Answer 2

obstruction, dysmotility, post op, congenital

Question 3

Which of the 3 types of intestinal failure are acute or chronic?

Answer 3

1. Acute- Type 1, 2

2. Chronic - Type 3

Question 4

What is Type 1 intestinal failure?

Answer 4

Self limiting, Short term. Either post-op or paralytic ileus.

Question 5

What is Type 2 intestinal failure?

Answer 5

Prolonged, associated with sepsis, metabolic or surgical complications.

Question 6

What is Type 3 intestinal failure?

Answer 6

Long term, parenteral nutrition needed

Question 7

What is the management of Type 1 failure?

Answer 7

1. Replace fluids, Correct electrolytes
2. Parenteral nutrition- if unable to tolerate oral fluids./food
3. Acid suppression drugs
4. Allow some enteral feeding

Question 8

What is parenteral feeding?

Answer 8

IV admission of nutrients. May be supplemental or only source of nutrition

Question 9

What are the two types of access used in parenteral feeding?

Answer 9

1. Central- central catheters used in tunnelled subclavian vein central lines
2. Peripheral- central catheters used in peripheral veins.

Question 10

What are some complications of using parenteral feeding? (5)

Answer 10

1. Sepsis
2. SVC thrombosis
3. Nutritional toxicity
4. Psycho-social
5. Line leakage/fracture

Question 11

Type 2 intestinal failure patients often develop this as a result of _

Answer 11

Sepsis.
Also seen in perioperative feeding complications

Parenteral +/- enteral feeding

Question 12

What are the management options in Type 3 failure? (4)

Answer 12

1. Home parenteral nutrition
2. Intestinal transplantation
3. Teduglutide treatment
4. Bowel lengthening

Question 13

Two methods of bowel lengthening?

Answer 13

1. Longitudinal lengthening- splitting the bowel into before joining the longitudinal lengths together.
   Increases length but reduced radius
2. Serial transverse enteroplasty- Little cuts are made in a zig zag pattern along the bowel, increasing amount of absorption

Question 14

What is the choice of treatment in chronic intestinal failure?

Answer 14

Home parenteral nutrition

Question 15

What is short bowel syndrome?

Answer 15

Length of small bowel insufficient to meet nutritional needs without artificial support

Has to be less than 200cm of small bowel
Normal length- 250-850

Question 16

Small bowel transplantation is mostly successful. T/F?

Answer 16

True

Question 17

Main complication of small bowel transplant? (2)

Answer 17

1. Liver failure

2. Loss of venous access