Short bowel syndrome

Posted by e-Medical PPT Wednesday, January 11, 2012
Short bowel syndrome is a malabsorption  disorder caused by the surgical removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel. Most cases are acquired, although some children are born with a congenital short bowel. It usually does not develop unless more than two thirds of the small intestine have been removed.
Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in vitamins  A, D, E, K, and B12, calcium, magnesium, iron, folic acid, and zinc. These may appear as anemia, hyperkeratosis (scaling of the skin), easy bruising, muscle spasms, poor blood clotting, and bone pain.
The symptoms of short bowel syndrome can include:
    * Abdominal pain
    * Diarrhea and steatorrhea (oily or sticky stool, which can be malodorous)
    * Fluid depletion
    * Weight loss and malnutrition
    * Fatigue
Short bowel syndrome in adults is usually caused by surgery for:
    * Crohn's disease, an inflammatory disorder of the digestive tract
    * Volvulus, a spontaneous twisting of the small intestine that cuts off the blood supply and leads to tissue death
    * Tumors of the small intestine
    * Injury or trauma to the small intestine
    * Necrotizing enterocolitis (premature newborn)
    * Bypass surgery to treat obesity, a now commonly performed surgical procedure
    * Surgery to remove diseases or damaged portion of the small intestine

Treatment include:
    * Anti-diarrheal medicine (e.g. loperamide, codeine)
    * Vitamin, mineral supplements and L-Glutamine powder mixed with water
    * H2 blocker and proton pump inhibitors to reduce stomach acid
    * Lactase supplement (to improve the bloating and diarrhoea associated with lactose intolerance)
    * Surgery, including intestinal lengthening, tapering, and small bowel transplant.
    * Parenteral nutrition (PN or TPN for total parenteral nutrition - nutrition administered via intravenous line).
    * Nutrition administered via gastrostomy tube

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