Short bowel syndrome

Question 1

what is short bowel syndrome and what are the problems associated with this condition?

Answer 1

1) Patients with a shortened bowel due to large surgical resection (with or without stoma formation)
2) medical management to ensure adequate absorption of nutrients and fluid. Absorption of oral medication is also often impaired

Question 2

list the common deficiencies that can occur in those with short bowel syndrome

Answer 2

1) Vitamins A, B12, D, E, and K
2) Essential fatty acids
3) Zinc, magnesium
4) Selenium

Question 3

which electrolyte deficiency is common in those with short bowel syndrome and how it is managed?

Answer 3

Hypomagnesaemia: treated with oral or intravenous magnesium supplementation. (Administration of oral magnesium may cause diarrhoea)

Question 4

What are the non-pharmacological measures that can be used to manage diarrhoea in short bowel syndrome? (2)

Answer 4

1) Oral rehydration salts - promote adequate hydration
2) Reducing food intake will lessen diarrhoea, but exacerbate undernutrition. A patient may require parenteral nutrition to allow them to eat less, if the extent of diarrhoea is unacceptable.

Question 5

which anti-motility drugs can be used in short bowel syndrome?

Answer 5

1) Loperamide
2) Codeine
3) Co-phenotrope

Question 6

1) why is Loperamide preferred to codeine in the treatment of diarrhoea associated with short bowel syndrome?
2) when would codeine be added to therapy?

Answer 6

1) Loperamide preferred as it is not sedative and does not cause dependence or fat malabsorption
2) If the desired response is not obtained with loperamide codeine may be added to therapy

Question 7

Co-phenotrope has been used alone or in combination to decrease faecal output. What are the side effects associated with this drug that restricts its use? (2)

Answer 7

1) Co-phenotrope crosses the BBB and can produce central nervous system side-effects
2) The potential for dependence and anticholinergic effects may also restrict its use.

Question 8

Colestyramine can be used to bind the unabsorbed bile salts and reduce diarrhoea. what should be monitored in patients prescribed this drug?

Answer 8

monitor for evidence of fat malabsorption (steatorrhoea) or fat-soluble vitamin deficiencies

Question 9

why antisecretory drugs be given in short bowel syndrome?

Answer 9

Drugs that reduce gastric acid secretion reduce jejunostomy output. (omeprazole can be used)

Question 10

what are the benefits of using growth factors in short bowel syndrome and which drug is licenced for use ?

Answer 10

1) Facilitate intestinal adaptation after surgery- enhancing fluid, electrolyte, and micronutrient absorption
2) Teduglutide- (C/I in active or suspected malignancy)

Question 11

Outline which factors can alter the absorption of drugs with regards to the intestines (3)

Answer 11

1) Important factors are the length of intestine available , and which section has been removed
2) Small intestine, most important site. Higher possibility that drug absorption will be affected if a large proportion of this is removed
3) Gastric emptying and gastric transit time, also affect drug handling.

Question 12

Many drugs some may need to be prescribed in much higher doses than usual in short bowel syndrome, list 4

Answer 12

1) Levothyroxine
2) Warfarin
3) Oral contraceptives
4) Digoxin

Question 13

which forms of drugs are not suitable to be used in those with short bowel syndrome?

Answer 13

Enteric-coated and modified-release preparations

Question 14

which forms of drugs are suitable to be used in short bowel syndrome?

Answer 14

1) soluble tablets
2) Uncoated tablets and liquid formulations
↳ Hyperosmolar liquids and some excipients (such as sorbitol) can result in fluid loss