Ch 30: Short Bowel Syndrome

Question 1

Proximal 100 cm of jejunum is primary site of what absorption?

Answer 1

CHO, protein, and water-soluble vitamin absorption

Question 2

If able to use EN for a SBS, which type of EN formula is generally recommended?

Answer 2

Isotonic polymetric formula is recommended, though some patient may need semi elemental formulas

Elemental formulas should be avoided b/c of hypertonicity, expense, and lack of evidence of benefit over standard formula

Fiber containing formulas may be beneficial to patient with SBS who has intact colon

Question 3

Which part of the small bowel has the most potential for adaptation?

Answer 3

Ileum

Question 4

In SBS, how long does intestinal adaptation generally take?

Answer 4

1-2 years

Question 5

What are the 3 anatomical variants of SBS based on remaining bowel segments?

Answer 5

Jejunoileocolonic anastomosis
Jejunocolonic anastomosis
End jejunostomy

Question 6

Why are commercial sports drinks not good substitutes for ORS?

Answer 6

Because they contain less sodium and more sugar than patients need for enhanced absorption

Question 7

What is colonic salvage?

Answer 7

A process where soluble fiber and some starches can be converted to SCFA by colonic bacterial fermentation and used as energy

Question 8

What is a prognostic biomarker of intestinal function?

Answer 8

citrulline, an nonessential AA found to correlated w/ eventual independence from PN when serum levels > 15-20 mcmol/L

Question 9

How much residual small bowel is needed for each anatomical variant of SBS is needed to wean off of PN?

Answer 9

Jejunoileocolonic anastomosis- 30 cm
Jejunocolonic anastomosis- 60 cm
End jejunostomy- 100 cm

Question 10

An elevated PTH is a marker of insufficient what?

Answer 10

Vitamin D and increased bone turnover

Question 11

What bone disease are patients with SBS at risk for developing?

Answer 11

Osteoporosis/osteopenia

Question 12

What is the minimal amount of urine output a SBS should have?

Answer 12

1 liter/day

Question 13

Stable adult patients with SBS usually absorb about ____ of energy that healthy individuals absorb

Answer 13

1/2 -2/3rds; Patients may need to increase dietary intake by about 50% and up to 400% above their estimated needs; this is best done with 5-6 small meals

Question 14

Where are most medications absorbed in the small intestine?

Answer 14

Within the first 50 cm of the jejunum; therefore, most medications can be used in patients with SBS; however, delayed release meds should be avoided

Question 15

What are the estimated kcal/protein needs for a patient with SBS?

Answer 15

35-45 kcal/kg/day–may need up to 60 kcal/kg/day

1.5-2.0 g/kg/day or 20-30% of goal

Question 16

What dietary advance should you give to a SBS patient who retains a colon?

Answer 16

Patients who retain a colon are advised to consume low fat, low oxalate diet, increase calcium intake (800-1200 mg/day in divided doses), and remain well hydrated (maintaining UOP > 1.2 L/day

Question 17

Gastric hypersecretions following significant small bowel resection can become problematic. Which medications have shown to be the most successful in suppressing gastric hypersecretion?

Answer 17

PPIs

Both histamine2-receptor antagonists (H2-blockers) and proton pump inhibitors (PPIs) have been used to treat gastric hypersecretion; however, PPIs are more effective at suppressing acid than H2-blockers. As PPIs are absorbed in the small bowel, higher than standard initial doses for oral administration may be required in SBS patients. Alternatively, oral dissolving tablets may be beneficial. Delayed release forms should be avoided in SBS patients. Cholestyramine is used for diarrhea associated with excess fecal bile acids. Loperamide is used to slow intestinal transit.

Question 18

Which metabolic complications may occur in patients with short bowel syndrome and small bowel intestinal bacterial overgrowth?

Answer 18

Metabolic acidosis

Question 19

What is the optimal sodium concentration of an oral rehydration solution for patients with short bowel syndrome?

Answer 19

90 - 120 mmol/L; This amount of sodium promotes jejunal absorption.

Question 20

The presence of what significantly improves fluid and electrolyte absorption as well as uptake of short-chain fatty acids and may allow survival without PN with as little as 60 cm of small bowel?

Answer 20

The presence of an ileocecal valve and colon