Intestinal Failure from Salford

Session 1: 09:30-10:15 (45min)

Definitions, prevalence, aetiology of intestinal failure

·  Definition of type 1-3 intestinal failure

·  Incidence and prevalence (UK vs international)

·  Prevalence by cause in the UK

·  Anatomy vs physiology of IF. (jejunostomy, short bowel, presence vs absence of colon, adaptation)

A. King

Session 2: 10:15-11:00 (45 min)

Management of the abdominal catastrophe

·  First principles

·  Damage control

·  Open abdomen as a tool to gain control

·  Laparostomy vs mesh-mediated traction

·  Re-look laparotomy: anastomosis, staple and leave or all ends out and why (planning for the future)

Common pitfalls and how to avoid them

D. McWhirter

Tea/Coffee

Session 3: 11:15-12:00

The surgical IF ward round: Clinical challenges and common problems in managing the complex IF surgical patient

To cover:

Ø  Psychiatry and its role

Ø  Vascular access and complications

Ø  Electrolytes and re-feeding

Ø  Complications of PN

High output fistula/stoma

A. Teubner

Session 4: 12:00-12:30

Nutrition and nutritional intervention in IF

·  Calculating nutritional requirements

·  Strategies and options for nutritional intervention. (PN, EN, distal feeding, etc.)

·  Planning and implementing nutritional support

·  Basic principles of formulation of enteral and parenteral nutrition

·  Monitoring patients on nutritional support

·  Outcomes

K. Farrar

Lunch

13:00- 13:30 Key Paper Presentation. Hot topics and SBAs

Session 5: Clinical scenarios and discussion: Chair Prof. G. Carlson

2x circa 30 minute lectures followed by case-based management scenarios (MDT style)

13:30-14:00

(30min)

Operative planning in the context of intestinal failure

·  First principles of initial case selection

·  Fistula management (SNAP)

·  How long to wait? How to aid spontaneous closure and when to accept futility

·  Management of the high output fistula/stoma

·  Optimisation of patients: options, medication and nutritional interventions (Nb: see below)

J. Epstein

14:00-14:30

(30min)

Managing the abdominal wall in IF surgery

Topics to include:

·  Planning

·  Adjuncts (botox/PPP)

·  Mesh choice and decision algorithm

·  Managing skin and soft tissues

D. Slade

Session 6: 14:30-15:00

Case based management discussions

J. Epstein

D. Slade

G. Carlson

D. McWhirter

Break

Session 7: 15:15-15:45 (30min)

Anaesthetics and critical care in context of Intestinal Failure

·  Pre-assessment of the IF patient

·  CPET testing and its role

·  Intra-operative considerations

·  Critical care and incidence of MODS in IF

Dr Pratt

Session 8: 15:45-16:15 (30min)

Intestinal failure in the UK: Service provision, structure of service and when to refer

C. Richardson

16:15-16:30

(15min)

Close of day: Questions and discussion

C. Richardson