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36 1.2 IF

front 1

how much nutrients lost in feces (%)

back 1

5%

front 2

IF definition

back 2

The reduction of gut function below the minimum necessary for the absorption of macronutrients and/or fluids and electrolytes that interavenous support is required to maintain health and growth

front 3

Intestinal insuffiency

back 3

the reduction in the absorptive function of the gut that does not require intravenous supplementation to maintain heath or growth

front 4

(true or false) patients receiving IV nutrition means intestinal failure

back 4

false

patients receiving IV nutrition not necessarily intestinal failure

front 5

Functional or chronological classification of IF

back 5

Type 1 (self-limiting, short-term) (inflammation, post operative ileus)

Type 2 (prolonged) (GI complications, abdominal sepsis, enterocutaneous fistula)

Type 3 (chronic) (volvous, NEC, SBS, crohns)

front 6

Pathological Classification of IF

back 6

  1. SBS (most common cause)
  2. Intestinal dysmotility (second most common)
  3. Enterocutaneous fistula
  4. Mechanical occlusion
  5. Extensive small bowel mucosal disease

front 7

Normal length of small bowel (adults and pediatrics)

Cutoff for SBS

back 7

Pediatrics ~ 2 m

Adults ~ 2.75-8 m

<200cm

front 8

Genetic Predisposition to Crohn's Disease

back 8

– Concordance rates: MZ twin 30%; DZ twins 4%

– NOD2, IL23

front 9

SBS types

back 9

  1. Type 1: End jejunostomy/ileotomy
  2. Type 2: Jejuno-colonic anastomosis
  3. type 3: Jejuno-ileal-colonic anastomosis

front 10

Mucus fistula refeeding

back 10

Reinfuses proximal stoma effluent into the distal bowel to enhance nutrient absorption, promote bowel adaptation, and reduce dependence on parenteral nutrition.

  • Used in babies with extensive bowel resection and stoma
  • Randomised controlled trial underway in neonates
  • Messy, difficult, controversial, complications
  • Some experience in adults but no RCTs

front 11

Intestinal dysmotility main cause

back 11

Chronic Intestinal Pseudo-Obstruction (CIPO)

  • dysmotile bowel (neuropathic, myopathic)
  • Symptoms (nausea, vomiting, abdominal pain, SBO)

front 12

St. Mark's solution contents

back 12

  • 1 Liter water
  • 20 g Glucose
  • 2.5g Sodium bicarbonate
  • 3.5g Sodium chloride

front 13

Pharmacological treatment of IF

back 13

1. Anti-motility Drugs (Codeine Phosphate, Loperamide)

- increase transit time and absorption

2. Anti-secretory Drugs (Proton Pump Inhibitors, Octreotide)

- reduce diarrhoea

3. Teduglutide (Glucagon-Like Peptide-2 analogue)

- improve intestinal adaptation