Short Bowel Syndrome

Question 1

What are the causes of shortened bowel? (4)

Answer 1

Large surgical resection following:

• Crohn’s
• cancer
• injuries
• ischemic bowel

Question 2

What are the aims of treatment in short bowel syndrome? (2)

Answer 2

1. Ensure adequate nutrition

2. Ensure adequate drug absorption

Question 3

Patients with a short bowel may require replacement of ___________ and __________ depending on the extent and position of the bowel resection

Answer 3

vitamins

minerals

Question 4

Which deficiencies can occur in short bowel syndrome? (9)

Answer 4

Vitamins:
1. A
2. B12
3. D
4. E
5. K
(Fat-soluble vitamins ADEK and B12)

Minerals:

6. Zinc
7. Selenium
8. Magnesium

AND:
9. Essential fatty acids

Question 5

Oral magnesium supplementation may result in _______________

Answer 5

Diarrhea

Question 6

What is the main complication of diarrhea in short bowel syndrome?

Answer 6

Dehydration; use of ORT can be considered in order to promote adequate hydration

Question 7

In patient with short bowel syndrome, oral intake influences the volume of stool passed, so reducing food intake will lessen ______________, but will also exacerbate the problems of _____________. A patient may require parenteral nutrition to allow them to eat less, if the extent of diarrhoea is unacceptable.

Answer 7

diarrhea

undernutrition

Question 8

What is the preferred anti motility drug used in short bowel syndrome?

Answer 8

Loperamide (not sedative and does not cause dependence or fat malabsorption)

Codeine may be used as a second line agent if treatment with loperamide is inadequate

Question 9

In patients with an intact colon and less than 100 cm of ileum resected, _______________ can be used to bind the unabsorbed bile salts and reduce diarrhoea.

Answer 9

colestyramine

*When colestyramine is given to these patients, it is important to monitor for evidence of fat malabsorption (steatorrhoea) or fat-soluble vitamin deficiencies

Question 10

When colestyramine is given to patients with short bowel syndrome, it is important to monitor for evidence of ________________ or ______________

Answer 10

fat malabsorption (steatorrhoea)

fat-soluble vitamin deficiencies

Question 11

Drugs that __________________ reduce jejunostomy output in patients with short bowel syndrome

Answer 11

reduce gastric acid secretion

Question 12

Drugs that gastric acid secretion reduce ________________ in patients with short bowel syndrome

Answer 12

jejunostomy output

*Use of a proton pump inhibitor alone does not eliminate the need for further intervention for fluid control (such as antimotility agents, intravenous fluids, or oral rehydration salts)

Question 13

_____________ can be used to facilitate intestinal adaptation after surgery in patients with short bowel syndrome, thus enhancing fluid, electrolyte, and micronutrient absorption

Answer 13

Growth factors

Question 14

Teduglutide is an analogue of __________________ which is licensed for use in the management of short bowel syndrome

Answer 14

endogenous human glucagon-like peptide 2 (GLP-2)

Question 15

______________ is an analogue of endogenous human glucagon-like peptide 2 (GLP-2) which is licensed for use in the management of short bowel syndrome

Answer 15

Teduglutide

Question 16

Many drugs are incompletely absorbed by patients with a short bowel and may need to be prescribed in ________________ than usual (such as levothyroxine, warfarin, oral contraceptives, and digoxin) or may need to be given ______________

Answer 16

much higher doses

intravenously

Question 17

What are the most important factors in determining the degree of drug absorption in a patient with small bowel resection? (3)

Answer 17

1. Which section was removed
2. How much bowel is remaining and available for absorption
3. Gastric emptying and gastric transit time

**small bowel, with its large surface area and high blood flow, is the most important site of drug absorption

Question 18

Which part of the GIT is the most important for drug absorption?

Answer 18

Small bowel; larger the amount removed, the higher the possibility that drug absorption will be affected

Question 19

Are enteric-coated and modified-release preparations of medications better for patients with short bowel syndrome?

Answer 19

NO; unsuitable for these patients, particularly in patients with an ileostomy, as there may not be sufficient release of the active ingredient

Dosage forms with quick dissolution (soluble tablets) should be used as well as uncoated tablets and liquid formulations

Question 20

Before prescribing liquid formulations to patients with short bowel syndrome, prescribers should consider the _____________, ______________, and ________________.

Answer 20

osmolarity

excipient content

volume required

• Hyperosmolar liquids and some excipients (such as sorbitol) can result in fluid loss