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11 - Fundamentals of intestinal failure and nutrition

Published online by Cambridge University Press:  03 May 2011

Tim Campbell Smith
Affiliation:
University College London Hospitals, London
Alistair Windsor
Affiliation:
University College London Hospitals, London
Andrew Kingsnorth
Affiliation:
Derriford Hospital, Plymouth
Douglas Bowley
Affiliation:
Heart of England NHS Foundation Trust
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Summary

Introduction

Intestinal failure (IF) exists when a patient cannot maintain their fluid balance and nutritional needs independently through the enteral route (i.e. orally). This is due to a loss of functioning gut. In most patients this loss of function is temporary, for example, immediately following abdominal surgery when intravenous fluids and or PN are required until gastrointestinal function returns. This resolves without any long-term sequelae. However, some patients develop a long-term reduction in functioning intestine. The management of these cases is complicated and care under a specialist multidisciplinary team maximizes the likelihood of an optimum outcome. Some of these patients may require long-term intravenous nutrition or bowel transplantation. Shaffer recently set out a classification of IF identifying the differences in duration and severity.

  1. Type 1 – self-limiting IF as occurs following abdominal surgery

  2. Type 2 – IF in severely ill patients with major resections of the bowel, with septic, metabolic and nutritional complications requiring multidisciplinary intervention with metabolic and nutritional support to permit recovery

  3. Type 3 – chronic IF requiring long-term nutritional support.

Such a devastating condition has a huge impact on their lives and ability to live independently as well as considerable cost and resource implications for the healthcare provider. In the UK there are several supra-regional centres caring for these patients.

Type
Chapter
Information
Fundamentals of Surgical Practice
A Preparation Guide for the Intercollegiate MRCS Examination
, pp. 173 - 180
Publisher: Cambridge University Press
Print publication year: 2011

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References

Annual BANS report, 2008; Artificial Nutrition Support in the UK 2000–2007. Available at http://www.bapen.org.uk ISBN 978–1–899467–26–6.
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