Clinical Management of Intestinal Failure

A complex disease entity, intestinal failure (IF) has only recently become accepted as a distinct clinical syndrome. Improvements across a wide range of disciplines?including critical care and organ transplantation as well as surgical, medical, and nutritional therapies?have led to a steady rise in survival and quality of life for patients with IF. Taking a current, multidisciplinary approach to their care, Clinical Management of Intestinal Failure offers intensive discussion of medical and nutritional issues in adults and children with intestinal failure. It addresses all facets of IF, including epidemiology, clinical presentation, intestinal rehabilitation, and transplantation.

Topics covered include:

• Etiology and epidemiology
• Pathophysiology and clinical assessment
• Medical and surgical management
• Prevention and treatment of complications
• Nursing management
• Emerging diagnostic and therapeutic methods
• Long-term care

Reflecting the diverse nature of IF clinical care and research, this book is written by a group of expert clinician scientists that includes gastroenterologists, surgeons, nurses, pharmacists, dietitians, social workers, and patients. They show how a multidisciplinary approach to patient care is instrumental in achieving optimal patient outcomes through more efficient lines of communication, improved monitoring of medications and their effects, detailed evaluation of growth parameters, and facilitation of the creative process that can lead to research breakthroughs.

Advancing the discipline of IF, this book summarizes the current state of the art of patient management as well as new developments in the science of tissue engineering, medical and surgical therapy, and transplantation.

Introduction. Intestinal Failure. Etiology and Epidemiology of Intestinal Failure. Pathophysiology of Intestinal Failure. Motility Disorders in Intestinal Failure. Clinical Assessment of Intestinal Failure in Children. Clinical Assessment of Intestinal Failure in Adults. Gastrointestinal Endoscopy and Pathologic Findings. Radiographic Evaluation. Medical and Surgical Management. Principles of Bowel-Preserving Surgery. Medical and Nutritional Management. Parenteral Nutrition in Children. Parenteral Nutrition in Adults. Vascular Access Devices. Enteral Access. Transition to Enteral Nutrition. Drug Dosing and Pharmacokinetics. Autologous Intestinal Reconstruction Surgery. Intestinal Transplantation. Critical Care Management. Prevention and Treatment of Complications of Intestinal Failure. Central Venous Catheter Infections: Prevention and Treatment. Intestinal Failure–Associated Liver Disease. Use of Parenteral Fish Oil in the Management of IF–Associated Liver Disease. Osteopenia and Bone Health in Patients with Intestinal Failure. Micronutrient Deficiencies in Intestinal Failure. Bacterial Overgrowth of the Small Intestine. Nursing Management. Ostomy Management. Central Venous Catheter Care. Medication Administration in the Enterally Fed Patient. Emerging Diagnostic and Therapeutic Methods. Intravenous Fat Emulsions. Probiotics and Prebiotics. Tissue-Engineered Intestine. Assessment of Mucosal Mass and Hormonal Therapy. Long-Term Care. Home Parenteral and Enteral Nutrition. Quality of Life. Social and Medical Insurance Issues. Oral Aversion. A Patient’s Perspective. Ethical Issues in Patient Care. Support Groups. Index.

Christopher Duggan, MD, MPH, has been performing clinical studies in the fields of pediatric nutrition, gastroenterology, and global health for over 20 years. He is an attending pediatric gastroenterologist and nutrition physician at Children’s Hospital Boston where he directs the Clinical Nutrition Service. He is the medical director of the Center for Advanced Intestinal Rehabilitation, one of the largest centers in the United States for the care of children with intestinal failure/chronic diarrhea syndromes. His funded research efforts include trials of nutrient supplementation in women and children susceptible to infectious diseases in Tanzania, India, and other countries. He is the codirector of the Harvard College course Nutrition and Global Health and mentors undergraduate, graduate, and postdoctoral students at Harvard. He is an associate professor of pediatrics at Harvard Medical School and an associate professor in the Department of Nutrition at Harvard School of Public Health.

Kathleen M. Gura