Nourani: Short Bowel Syndrome

Question 1

Malabsorption syndrome that results from extensive intestinal resection

Answer 1

short bowel syndrome

Question 2

In practice, small bowel length of less than (blank) cm is commonly used as an anatomic definition of short bowel syndrome

Answer 2

200

Question 3

Inflammatory bowel disease; Crohns/UC
Mesenteric infarction
Radiation injury

Answer 3

Major causes of short bowel syndrome in adults

Question 4

Congenital anomalies

Answer 4

major cause of short bowel syndrome in infants and children

Question 5

The degree of malabsorption depends on which area of the gut is resected. Which section can be resected with the most mild clinical manifestations? The worst?

Answer 5

ileocolonic anastamosis; jejunocoonic anastamsosis

Question 6

Predominant clinical symptoms of SBS

Answer 6

diarrhea, steatorrhea, weight loss, mineral deficiencies, hypovolemia, low Na+, low K+

Question 7

Some patients can meet caloric and protein needs but still are deficient in (blank). Others have adequate nutrient uptake, but (blank) losses are predominant.

Answer 7

vitamins and minerals; fluid and electrolytes

Question 8

predictor of permanent versus transient intestinal failure

Answer 8

citruline concentrations

Question 9

In humans, (blank) is an amino acid involved in metabolism that is not incorporated in proteins. In the urea cycle, it produces urea from ammonia. Circulating form is mainly produced by enterocytes of the small bowel

Answer 9

citrulline

Question 10

Loss of Absorptive Surface Area
Loss of Site-Specific Transport Processes
Loss of Site-Specific Endocrine Cells and GI Hormones
Loss of the Ilecocecal valve
Intestinal Adaptation to Resection

Answer 10

Pathophysiology of short bowel syndrome

Question 11

The jejunum and ileum are relatively (blank) in terms of mucosal resistance, while the proximal and distal colon is very (blank).

Answer 11

leaky;tight

Question 12

Absorption of some compounds is restricted to certain areas of the small intestine. This can lead to loss of (blank)

Answer 12

site-specific transport processes

Question 13

GI hormones are synthesized in the intestinal mucosa by (blank). These can be lost in bowel resection.

Answer 13

site-specific endocrine cells

Question 14

50% of patients with extensive intestinal resections temporarily develop (blank)

Answer 14

hypergastrinemia = increased gastric acid secretion

Question 15

What do GLP1 and GLP2 do in the gut? What happens to these hormones in patients with SBS?

Answer 15

cause a delay in gastric emptying, so they slow intestinal transit; increased levels

Question 16

Primary function is to
separate ileal and colonic contents
minimize bacterial colonization of the small intestine
regulate emptying of ileal contents into the colon

Answer 16

ileocecal valve

Question 17

Two problems with removing the ileocecal valve

Answer 17

decreased transit time through intestines

increases risk of bacterial overgrowth in small bowel

Question 18

Within 1 to 2 years, what adaptive changes can occur in the ileum to make it more like the jejunum?

Answer 18

ileum attains taller villi and deeper crypts. Can also increase in length and diameter.

Question 19

(blank) is the result of an increase in crypt cell production rate presumably mediated by growth factors released by the presence of food and secretions in the intestinal lumen.

Answer 19

adaptive hyperplasia

Question 20

Patients with SBS with colon in continuity have changes in (blank) that result in an increased capacity to metabolize carbohydrate and in an increased fecal bacterial mass.

Answer 20

colonic flora

Question 21

1. admin of parenteral nutrition

2. prevention of fluid/electrolyte abnormalities

Answer 21

predominant goals after intestinal resection

Question 22

(blank) can be given to suppress gastric hypersecretion

Answer 22

H2 blocker/PPI

Question 23

Continuous (blank) feeding in post-op period can significantly increase net absorption of nutrients. Also, (blank) diets enhance adaptation more readily than elemental diets.

Answer 23

tube feeding; complex

Question 24

Many enteral feeding formulations, especially amino acid solutions, are high in (blank) content.

Answer 24

carbohydrate

Question 25

Principle luminal anions in colon
2-4 carbon compounds that originate from bacteria metabolizing carbohydrates
Rapidly cleared from the colon to enhance Na+ absorption

Answer 25

short chain fatty acids

Question 26

Malabsorbed carbohydrates and proteins are degraded by bacterial enzymes in the colon to (blank) and lactate, which are readily absorbed by colonic epithelium

Answer 26

short chain fatty acids

Question 27

(blank) enteral feeding permits constant saturation of carrier transport proteins

Answer 27

continuous

Question 28

With chronic enteral nutrition, avoid high (blank) feedings, because simple carbs may cause osmotic diarrhea

Answer 28

carb

Question 29

(blank) will often improve diarrhea associated with bile salt malabsorption.

Answer 29

cholestyramine