Short bowel syndrome
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Transcript of Short bowel syndrome
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By Amnah Azim
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Learning Objectives To know what is Short bowel syndrome
To know about changes in small bowel after resection
Learn how to manage with different medical n surgical strategies.
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Short Bowel Syndrome Short bowel syndrome is a spectrum of
pathophysiological disorder that occurs as a consequences of insufficient absorptive and digestive small intestinal mucosal surface area. [1]
OR Parental nutrition dependence for greater than
3 months.[2]
Ref : 1. Warner BW ,Small bowel syndrome, text book of pediatric surgery 6th edition 2 Jaksic T , ,Small bowel syndrome, text book of pediatric surgery 7th edition
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EtiologySmall Gut Length
Mid gut volvulus
Intestinal atresia
NEC
Gastroschiasis
Functional Disorders
Aganglionosis
Idiopathic intestinal obstruction
Crohn’s disease
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Gut Resection Rickham (1967) – an extensive resection to maximum of
75cm
Kuffer (1972) – 15cm with ileocaecal valve
- 38cm without ileocaecal valve
Dorney (1985) – 11cm with I/C valve or 25cm without I/C valve
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what happens when gut resected?
Acute phase : starts immediately and upto 3-4 months
Adaptation phase : starts immediately and last upto 12-24 months
Maintenance phase : absorptive capacity will be maximize.
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How does the bowel adapt? Cellular hypertrophy and
hyperplasia
Villi become taller
Crypts become deeper
Intestinal dilatation
Altered motility
Hormonal changes
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Medical management Fluid and electrolyte balance:
Fluid loss in ostomy, diarrhea + Normal fluid requirement +300~500ml for insensible loss
Enteral feeding can be initiated at 5-1o post op day if not surical complication occur.
Breast milk feeding is appropriate in infants due to abundance in epidermal growth factor
Lactose intolerance is not uncommon; glucose polymer is better.
Initiat TPN in high output ostomies and if not tolerating enteral feed .
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Fluid Management
Parrish. Pract Gastroenterol. 2005
Or 800ml urine with sodium 20mmol/L
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Pharmacologic Agents
High-dose loperamide
Codeine phosphate
H2 blocker (i.e. ranitidine)
Proton pump inhibitor (i.e. omeprazole)
Somatostatin analogue (octreotide)
Cholestyramine
Cholecystokinin
Antibiotics
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Surgical therapies Procedures that
Delay intestinal transit time
Construction of various valves and sphincters
Construction of anti-peristaltic (reversed) segments
Recirculating loops
Colonic interposition
Increase absorptive area
Intestinal tapering and lengthening
Small bowel transplantation
Isolated small intestinal graft
Combined liver/small intestinal grafts
Townsend et al. Sabiston Textbook of Surgery 17th Edition. 2004
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Tapering
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Bowel lengthening Cutting bowel longitudinally, preserve blood supply to
both sides and create a segment of bowel twice length, half diameter without loss of mucosal surface area.
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Bowel lengthening
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Antiperistaltic small intestine segment
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Colonic interposition
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Any Query??
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Thank you