Intestinal Failure Flashcards

1
Q

what is the definition of intestinal failure?

A

when gut is no longer able to supply the hydration and nutrition needs of the body

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2
Q

what types of intestinal failure are acute?

A

type 1 and 2

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3
Q

what types of intestinal failure are chronic?

A

type 3

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4
Q

what is type 1 intestinal failure?

A

self-limiting short term postop or paralytic ileus

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5
Q

what is type 2 intestinal failure?

A

prolonged, associated with sepis and metabolic conditions

often related to abdo surgery with complications

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6
Q

what is type 3 intestinal failure?

A

long term but stable

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7
Q

for what type of intestinal failure i home parenteral nutrition most likely to be indicated?

A

type 3 intestinal failure

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8
Q

what is the management of type 1 intestinal failure?

A

-replace fluid and correct electrolytes
-parenteral nutrition if unable to tolerate food/fluids 7+ days post op
(but allow as much enteral feeding as possible)
-acid suppresion (PPIs)
-octreotide
-alpha hydroxycholecalciferol

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9
Q

what is the purpose of octerotide?

A

reduced number of bowel movements

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10
Q

what is the purpose of alpha hydroxycholecalciferol?

A
preserves Mg
(diarrhoea can make you deficient)
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11
Q

why is acid suppression needed in type 1 intestinal failure?

A

because it is likely to be post op- operations on gut cause patient to produce a lot of acid

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12
Q

what are the 3 main types of venous access for parenteral nutrition?

A

peripherally inserted central catheter (PICC)
tunnelled catheter
vascuport

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13
Q

what imaging technique is used usually for guiding venous access for parenteral nutrition considering the tip of the catheters should rest in the SVC?

A

ultrasound-guided

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14
Q

what are the 3 main complications of obtaining venous access for parenteral nutrition?

A

pneumothorax
arterial puncure
misplacement

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15
Q

what is the biggest complication worry with parenteral nutrition and why?

A

sepsis

line is just above the heart so there is an infective endocarditis risk

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16
Q

describe a SNAP assessment of a patient with type 2 intestinal failure?

A
  1. assess Sepsis
  2. manage fluid/electrolyde balance and provide Nutrition
  3. radiological Assessment to find sepsis and fistula
  4. Plan surgical management
17
Q

what radiological tools are used to find fistulas?

A

CT scan

fistulography

18
Q

what is the cause of short gut syndrome?

A

the gut has been ressected during surgery and has been left with too little of small bowel to provide enough nutrition/hydration for bodies requirements

19
Q

what is the average length of small bowel?

A

250- 850cm

20
Q

how short is the small bowel in short bowel syndrome?

A

usually below 200cm

21
Q

what is the main benefit of HPN over intestinal transplant?

A

greater 5 year survival than patient who got an intestinal transplantation

22
Q

what is the main benefit of intestinal transplant over HPN?

A

ability to eat

23
Q

what are the 2 main indications for small bowel transplantation instead of HPN?

A

no more veins for venous access

liver disease