Short Bowel Syndrome | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

67

Pages:

4
Author:

Mariam A. A.

Short Bowel Syndrome Causes Adults Children Extensive resection Congenital Most common Necrotising enterocolitis Following: Most common? Mesenteric infarction Intestinal atresia Crohn’s disease Midgut volvulus Trauma Gastroschisis Radiation enteritis Key info Resection of the jejunum is better tolerated than the ileum Clinical Features Severity is influenced by length of remaining bowel Diarrhoea Fluid and electrolyte disturbances Nutrient malabsorption Ileal resection Even small resection can cause to malabsorption of bile salts and vitamin B12 Bile salt induced diarrhoea Steatorrhea and gallstone formation Oxaluria and oxalate stones B12 deficiency Investigations Bloods FBC Vitamin B12 Plasma albumin Important indicator of nutritional status Electrolytes Kidney and liver function tests Indictors of nutritional status SeHCAT test Imaging of the small bowel measurement of bile salt retention Gold standard for diagnosing bile acid malabsorption Patients swallow a capsule with a radioactive tracer Gamma camera scans the body on day one and again seven days later Schilling test Assessment of vitamin B12 Management Antidiarrhoeic therapy To reduce small bowel and colon motility Loperamide at 2 to 8 mg Up to 4 times daily 30 minutes before food Codeine at 30 to 60 mg up to 4 times daily 30 minutes before food If resection of the terminal ileum Disruption of the enterohepatic circulation -> bile salt malabsorption Cholestyramine at 4g orally Twice daily Maximum of 36 g daily Relieves bile salt diarrhoea by binding to bile salts But if more than 100cm of ileum removed -> increased bile salt elimination -> steatorrhea -> important to know how much of bowel resected All other drugs should either be taken at least 1 hour before or 4 to 6 hours after Omeprazole at 20 mg orally daily Half to one hour before meals if needed For patients with a high output state Especially the first few months after surgery Antisecretory therapy using somatostatin analogues E.g. octreotide or lanreotide For select patients -> reduce gastrointestinal fluids – decreases stoma fluid and electrolyte output Intestinotrophic therapy using teduglutide Patients who are on home parenteral nutrition Aims to wean parenteral nutrition requirements Complications Malnutrition Dehydration Vitamin/mineral deficiencies Severe diarrhoea Kidney stones Gallstones Liver disease (IFALD) Bacterial overgrowth Bone disease PN placement Steatorrhea Metabolic imbalances Increased infection risk D-lactic acidosis