SHORT BOWEL SYNDROME Flashcards
Short bowel syndrome
Shortened bowel due to large surgical resection
* Need to ensure adequate absorption of nutrients and fluid
Nutritional deficiencies
- Nutritional deficiencies:
- Replace Vit A, B/2, D, E, and K, essential fatty acids, zinc and selenium
Treatment (supplementation)
- Replace Vit A, B/2, D, E, and K, essential fatty acids, zinc and selenium
- PO or IV magnesium supplementation
- Alfacalcidol and correction of sodium depletion occasionally
Diarrhoea and high output stoma
- ORT = increase volume of stool passed
- Loperamide and codeine to reduce intestinal motility
- Co-phenotrope - decrease faecal output
- Colestyramine
Co-phenotrope
- BBB
- CNS SFx
- potential for dependence and anticholinergic effects
Colestyramine
- intact colon and less than 100cm of ileum resected
- binds to the unabsorbed bile salts to reduce diarrhoea
- monitor for fat malabsorption or fat soluble vitamin deficiencies
When can colestyramine be used in SBS?
intact colon and less than 100cm of ileum resected
Colestyramine - MOA
binds to the unabsorbed bile salts to reduce diarrhoea
Colestyramine - monitoring
monitor for fat malabsorption or fat soluble vitamin deficiencies
Antisecretory drugs
- Drugs that reduce gastric acid secretion reduce jejunostomy output
- omeprazole
- octreotide
Omeprazole administration in SBS
If less than 50cm of jejunum remains = IV
needs to be give with antimotility agent, IV fluids or PO ORT
Octreotide
- reduces diarrhoea and large volumes of jejunosotomy output by inhibiting multiple pro secretory substances
Growth factors
Facilitate intestinal adaptation after surgery
- teduglutide
Stoma
Artificial opening on the abdomen to divert flow of faeces or urine into an external pouch located outside body
Drug absorption in SBS
- Many drug incompletely absorbed
- May need to prescribe much higher doses or IV
- Consider length of intenstine available for absorption
