Small bowel

Question 1

What is intestinal failure?

Answer 1

Failure to maintain adequate hydration, nutrition or electrolyte homeostasis in the absence of artificial support.

Question 2

How much small bowel do we need to survive on?

Answer 2

It depends on which portion of small bowel and whether there is intact colon and whether this is in continuity.

If fully intact colon and in continuity then can survive on 35-40cm of small bowel.

If half colon e.g. small bowel to transverse colon anastomosis then need ~70cm of small bowel.

If end jejunostomy ~115cm.

Question 3

In patients with high output stomas or entercutaneous fistulas what can be done to try reduce the output volume?

Answer 3

• Proton pump inhibitor. (Can be in a state of hypergastrinaemia in first 6 months post resection)
• Loperamide is concentrated in the enterohepatic circulation so is very dose dependent. Can give up to 64mg/day.
• Caution in use of codeine given its additive nature.
• Limit hypotonic fluids to ~500ml/day
• Offer oral rehydration solution. Na 80mmol/L.
• Octreotide reserved for the worst because it has complications. causes gallstones, reduces motility, inhibits gut adaption.

Question 4

How does the bowel adapt after significant resection resulting in short or near short gut?

Answer 4

It is slow - maximal adaption is a t 2 years.

Nutritive and nonnutritive factors

Colon becomes a digestive organ.