short bowel syndrome Flashcards
pt with shortened bowel due to large surgical resection (with or without stoma formation) may require medical management to ensure…
adequate absorption of nutrients and fluid
true or false - absorption of oral meds is often impaired
true
deficiencies of the following can occur
A, B12, D, E, K
essential fatty acids, zinc, selenium
this electrolyte disturbance is common
hypomagnesesmia
hypomagnesiemia is common. it is treated with….
oral or IV magnesium supplementation
oral can cause diarrhoea
is diarrhoea common in short bowel syndrome
yes
what should you consider using in pt with diarrhoea
ORS to promote adequate hydration
oral intake influences the volume of stool passed. therefore reducing food intake will lessen diarrhoea, however….
it will also exacerbate the problems of undernutrition
if the extent of diarrhoea is unacceptable, a patient may require the following to allow them to eat less
parenteral nutrition
2 drugs that can reduce intestinal motility and thus exert antidiarrhoeal actions
loperamide
codeine
which drug is preferred for diarrhoea
loperamide as it is not sedative and does not cause dependence or fat malabsorption
high doses of loperamide may be needed in short bowel syndrome due to disrupted enterohepatic circulation with rapid GI transit time. if the desires response is not obtained with loperamide, then the following drug can be added to therapy
codeine
this drug has traditionally been used alone or in combo with other meds to help decrease faecal output. however it crosses BBB and can produce CNS SE which can limit its use. also has potential for dependence and anticholinergic effects.
co-phenotrope
in patients with intact colon and <100cm of ileum resected, the following drug can be used to bind to unabsorbed bile salts and reduce diarrhoea
(hint: cholesterol)
colesyramine
In patients with an intact colon and less than 100 cm of ileum resected, colestyramine can be used to bind the unabsorbed bile salts and reduce diarrhoea. When colestyramine is given to these patients, it is important to monitor for….
evidence of fat malabsorption (steatorrhoea) or fat-soluble vitamin deficiencies.
fat soluble vitamins A, D, E, and K
what can be given as an antisecretory drug and why
hint commonly used for ac..
PPI
Drugs that reduce gastric acid secretion reduce jejunostomy output.
Omeprazole can be used as an antisecretory drug because it reduces gastric acid and thus reduced jejunostomy output. it is readily absorbed in the duodenum and upper small bowel, but if less than 50 cm of jejunum remains…
then needs to be given IV
does the use of a PPI alone eliminate the need for further intervention for fluid control ?
NO
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).
this drug reduces ileostomy diarrhoea and large volume jejunostomy output by inhibiting multiple pro-secretory substances. however, there is insufficient evidence to establish its role in the management of short bowel syndrome.
Octreotide [unlicensed indication]
discuss use of growth factors
Growth factors can be used to facilitate intestinal adaptation after surgery in patients with short bowel syndrome, thus enhancing fluid, electrolyte, and micronutrient absorption.
What is teduglutide and discuss its use
Teduglutide is an analogue of endogenous human glucagon-like peptide 2 (GLP-2) which is licensed for use in the management of short bowel syndrome.
It may be considered after a period of stabilisation following surgery, during which intravenous fluids and nutritional support should have been optimised.
discuss drug absorption
Many drugs are incompletely absorbed by patients with a short bowel and may need to be prescribed in much higher doses than usual (such as levothyroxine, warfarin, oral contraceptives, and digoxin) or may need to be given intravenously.
Several factors can alter the absorption of drugs taken by mouth in patients with a compromised gastrointestinal system.
- most important factors: length of intestine available for drug absorption, and which section has been removed
- small intestine (large SA and high blood flow) is the most important site of drug absorption
- the larger the amount of small intestine removed, higher the possibility that drug absorption will be affected
- other factors such as gastric emptying and gastric transit time, also affect drug handling.
why are EC and MR preparations unsuitable for use in patients with short bowel syndrome, particularly in patients with an ileostomy
Enteric-coated and modified-release preparations are unsuitable for use in patients with short bowel syndrome, particularly in patients with an ileostomy, as there may not be sufficient release of the active ingredient.
what types of dosage form should be used in pt with short bowel syndrome esp in pt with ileostomy
and what considerations to make before prescribing liquid forms
Dosage forms with quick dissolution (soluble tablets) should be used. Uncoated tablets and liquid formulations may also be suitable.
Before prescribing liquid formulations, prescribers should consider the osmolarity, excipient content and volume required. Hyperosmolar liquids and some excipients (such as sorbitol) can result in fluid loss. The calorie density of oral supplements should also be considered, as it will influence the volume to be taken.
