Short Bowel Syndrome
the segment location:
- defines what nutrient deficiency will occur
- what gastroendrocine function will occur
- prox small intestine > loss of inhibition of gastic acid secretion, hypersecretion of juices
Complications
small intestine bacterial overgrowth (increased numbers and species) usually prevented by
- gastric acid (often needs to be suppressed in SBS)
- pancreatic enzyme activity
- enterocyte turnover
- antegrade peristaltic activity in the small intestine (dilation as part of adaptation impairs peristalsis)
- ileocecal valve prevents retrograde movement of colonic bacteria (often resected)
- enteral feeding (often not possible post op, again, reduced peristalsis > vicious cycle)
Can lead to bowel inflammation > bacteremia
bacteria deconjugate bile salts > fat and fat soluable vitamin malabsorption
bacteria waste toxin effect of gut > general malabsorption
Dx
Clinical
Duodenal aspirate and culture
Hydrogen breath test
Rx ?Metronidazole ?await sensitivities from culture
Prognosis:
most common cause of death: line septis, liver failure