how much nutrients lost in feces (%)

5%

IF definition

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

Intestinal insuffiency

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

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

false

patients receiving IV nutrition not necessarily intestinal failure

Functional or chronological classification of IF

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)

Pathological Classification of IF

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

Normal length of small bowel (adults and pediatrics)

Cutoff for SBS

Pediatrics ~ 2 m

Adults ~ 2.75-8 m

<200cm

Genetic Predisposition to Crohn's Disease

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

– NOD2, IL23

SBS types

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

Mucus fistula refeeding

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

Intestinal dysmotility main cause

Chronic Intestinal Pseudo-Obstruction (CIPO)

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

St. Mark's solution contents

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

Pharmacological treatment of IF

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