Nourani: Short Bowel Syndrome Flashcards
Malabsorption syndrome that results from extensive intestinal resection
short bowel syndrome
In practice, small bowel length of less than (blank) cm is commonly used as an anatomic definition of short bowel syndrome
200
Inflammatory bowel disease; Crohns/UC
Mesenteric infarction
Radiation injury
Major causes of short bowel syndrome in adults
Congenital anomalies
major cause of short bowel syndrome in infants and children
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?
ileocolonic anastamosis; jejunocoonic anastamsosis
Predominant clinical symptoms of SBS
diarrhea, steatorrhea, weight loss, mineral deficiencies, hypovolemia, low Na+, low K+
Some patients can meet caloric and protein needs but still are deficient in (blank). Others have adequate nutrient uptake, but (blank) losses are predominant.
vitamins and minerals; fluid and electrolytes
predictor of permanent versus transient intestinal failure
citruline concentrations
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
citrulline
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
Pathophysiology of short bowel syndrome
The jejunum and ileum are relatively (blank) in terms of mucosal resistance, while the proximal and distal colon is very (blank).
leaky;tight
Absorption of some compounds is restricted to certain areas of the small intestine. This can lead to loss of (blank)
site-specific transport processes
GI hormones are synthesized in the intestinal mucosa by (blank). These can be lost in bowel resection.
site-specific endocrine cells
50% of patients with extensive intestinal resections temporarily develop (blank)
hypergastrinemia = increased gastric acid secretion
What do GLP1 and GLP2 do in the gut? What happens to these hormones in patients with SBS?
cause a delay in gastric emptying, so they slow intestinal transit; increased levels
Primary function is to
separate ileal and colonic contents
minimize bacterial colonization of the small intestine
regulate emptying of ileal contents into the colon
ileocecal valve
Two problems with removing the ileocecal valve
decreased transit time through intestines
increases risk of bacterial overgrowth in small bowel
Within 1 to 2 years, what adaptive changes can occur in the ileum to make it more like the jejunum?
ileum attains taller villi and deeper crypts. Can also increase in length and diameter.
(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.
adaptive hyperplasia
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.
colonic flora
- admin of parenteral nutrition
2. prevention of fluid/electrolyte abnormalities
predominant goals after intestinal resection
(blank) can be given to suppress gastric hypersecretion
H2 blocker/PPI
Continuous (blank) feeding in post-op period can significantly increase net absorption of nutrients. Also, (blank) diets enhance adaptation more readily than elemental diets.
tube feeding; complex
Many enteral feeding formulations, especially amino acid solutions, are high in (blank) content.
carbohydrate
