Nourani

Question 1

What is short bowel syndrome?

Answer 1

It is a malabsorption syndrome from extensive intestinal resection.
Defined as when the small bowel is less than 200 cm in length.
Can lead to intestinal failure

Question 2

What is the spectrum of short bowel syndrome?

Answer 2

Limited Ileocolonic resections–>jejunocolonic anastomosis–>end jejunostomy
Mild–>Severe
**End jejunostomy dependent on parenatal nutrition

Question 3

What are the major causes of short bowel syndrome in adults?

Answer 3

Inflammatory Bowel Disease: Crohn’s & Ulcerative Colitis
Mesenteric Infarction
Radiation Injury

Question 4

What are the major causes of short bowel syndrome in children?

Answer 4

usu congenital anomalies:

gastroschisis, intestinal atresia, malrotation, necrotizing enterocolitis

Question 5

Other causes of short bowel?

Answer 5

volvulus
postsurgical complications
jejunoileal bypass
benign tumors

Question 6

What are the symptoms/results of short bowel syndrome?

Answer 6

Diarrhea
Steatorrhhea
weight loss
mineral/trace element deficiencies
hypovolemia + hyponatremia OR hypokalemia

Question 7

Why are serum citrulline concentrations a predictor of permanent or transient intestinal failure?

Answer 7

Citrulline is an amino acid that isn’t incorporated into proteins, but is a part of the urea cycle in the liver & kidneys.
It is produced by enterocytes in the small bowel & therefore the serum levels are indicative of how bad the damage is.

Question 8

List the reasons for why Short Bowel Syndrome does what it does. Pathophysiology.

Answer 8

Loss of absorptive surface area
Loss of site-specific transport processes
Loss of site-specific endocrine cells & gastrointestinal hormones
Loss of ileocecal valve
Intestinal adaptation to resection

Question 9

Where are GI hormones produced?

Answer 9

in the intestinal mucosa

Question 10

Where are gastrin, CCK, secretin, GIP, motilin produced?

Answer 10

by endocrine cells in the proximal Gi tract

Question 11

After intestinal resections, 1/2 the patients experience _______. People don’t know why. Perhaps loss of inhibitory signals.

Answer 11

hypergastrinemia

increased gastric acid secretions

Question 12

Where are the GI hormones GLP1, GLP2, & PYY produced? What do they do?

Answer 12

in the ileum & proximal colon

• *they are released by intraluminal fat & carbs & cause a delay of gastric emptying
• inhibit gastric acid secretion
• promote intestinal growth

Question 13

Where does most of the absorption in the SI take place?

Answer 13

in the proximal small bowel

Question 14

Which part of the small intestine is perfect for absorption?

Answer 14

the jejunum b/c of the tall villi & deep crypts

Question 15

What is better: to lose the jejunum or ileum?

Answer 15

Surprisingly, the jejunum. This is b/c the ileum is so good at adapting. It can make its crypts deeper & villi taller & increase its diameter & length. The ileum is what absorbs B12 & bile acids.
All areas do electrolytes & water.

Question 16

When does bacterial overgrowth occur?

Answer 16

when you eat one simple carb that one type of bacteria eats…then that one will overgrow…need to even it out with the bacteria.

Question 17

What’s the problem with losing your ileocecal valve?

Answer 17

This is what separates the ileal & colonic contents. It minimizes the bacterial colonization in the SI. It regulates the emptying of contents.
Removing it:
decreases intestinal transit time
increases risk of small bowel bacterial overgrowth
this overgrowth may worsen nutrient & cobalamin malabsorption

Question 18

How long does it take the ileum to fully adapt if say the jejunum is fully resected?

Answer 18

1-2 years

Question 19

What’s the problem with Mr. Short having a bunch of orange juice?

Answer 19

The sugar creates a hyper osmotic state, attracts water & worsens the diarrhea.

Question 20

What’s the problem with Mr. Short having a bunch of mayo & butter?

Answer 20

It adds lipids, which are already hard to break down & worsens the steatorrhea.

Question 21

Right after a bowel resection…how do you provide nutrition? What else do you do?

Answer 21

parenteral nutrition

H2 blocker/PPI to suppress gastric hypersecretion

Question 22

What’s the problem w/ gastric hyper secretion?

Answer 22

It deactivates the pancreatic enzymes.
It reduces the optimal pH needed for fat absorption.
It increases intestinal fluid losses.

Question 23

What’s the difference in how children v. adults handle the high carb enteral feeding formulas?

Answer 23

Children–have a problem
Adults–can ferment malabsorbed carbs into short chain fatty acids in the colon
This can generate 100 kcal/day

Question 24

How is it best to do enteral feeding soon after bowel resection?

Answer 24

continuous feeding

this causes saturation of the carrier proteins & takes full advantage of the absorptive area that is available.