Short Bowel Syndrome

Short bowel syndrome is a malabsorptive condition most commonly associated with extensive intestinal resection for etiologies such as Crohn’s disease, bowel obstruction, trauma, radiation therapy, and vascular insufficiency. The short length of bowel results in insufficient surface area for fluid and electrolyte absorption. Patients typically present with diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea, electrolyte abnormalities, and dehydration. Management options include antimotility agents, antisecretory agents, and total parenteral nutrition for patients who cannot maintain themselves with oral intake. Last-resort options include surgical intestinal lengthening procedures and small bowel transplant.

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Overview

Definition

  • Short bowel syndrome (SBS) is a malabsorptive condition due to the insufficient length of functional small intestine Small intestine The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum. Small Intestine. The condition leads to diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea, malnutrition Malnutrition Malnutrition is a clinical state caused by an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute severe malnutrition are marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema). Malnutrition in children in resource-limited countries, and dehydration. 
  • Intestinal failure is reduced GI function that cannot meet the minimum requirements for absorption of electrolytes Electrolytes Electrolytes are mineral salts that dissolve in water and dissociate into charged particles called ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for various basic life-sustaining functions. Electrolytes, water, and macronutrients.
    • May be permanent or transient
    • Caused by SBS, intestinal dysmotility, small bowel mucosal disease, mechanical obstruction, or intestinal fistula
    • Results in dependence on supplemental IV nutrition and hydration

Epidemiology

  • Rare condition
  • Incidence and prevalence are difficult to estimate.
  • Approximately 10,000–20,000 individuals in the United States are on total parenteral nutrition (TPN) due to SBS.

Etiology

  • Surgical resection of the small intestine Small intestine The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum. Small Intestine
    • Adults:
      • Mesenteric ischemia Mesenteric Ischemia Mesenteric ischemia is a rare, life-threatening condition caused by inadequate blood flow through the mesenteric vessels, which results in ischemia and necrosis of the intestinal wall. Mesenteric ischemia can be either acute or chronic. Mesenteric Ischemia
      • Trauma
      • Bowel obstruction
    • Pediatric population:
      • Necrotizing enterocolitis Necrotizing enterocolitis Necrotizing enterocolitis (NEC) is an intestinal inflammatory process that can lead to mucosal injury and necrosis. The condition is multifactorial, with underlying risk factors that include prematurity and formula feeding. The clinical presentation varies in severity from feeding intolerance, acute findings on abdominal exam, and systemic symptoms. Necrotizing Enterocolitis
      • Intestinal atresia
      • Midgut volvulus Volvulus A volvulus is the twisting or axial rotation of a portion of the bowel around its mesentery. The most common site of volvulus in adults is the colon; most frequently the sigmoid volvulus. Patients typically present with symptoms of bowel obstruction such as abdominal pain, distension, vomiting, and constipation/obstipation. Volvulus with ischemia
  • Functional disorder of the intestine
    • Crohn’s disease
    • Radiation enteritis
  • Congenital short bowel (rare)

Pathophysiology

Physiology

  • Jejunum:
    • Primary digestive and absorptive site
    • Contains:
      • ↑ Concentration of transport carrier proteins
      • Concentrated digestive enzymes Enzymes Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body's constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules. Basics of Enzymes
      • Long villi with ↑ absorptive surface
  • Distal ileum: 
    • Reabsorbs bile acids 
    • Vitamin B12 absorption
  • Colon:
    • Participates in absorption of water and electrolytes Electrolytes Electrolytes are mineral salts that dissolve in water and dissociate into charged particles called ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for various basic life-sustaining functions. Electrolytes
    • Metabolizes undigested carbohydrates Carbohydrates Carbohydrates are one of the 3 macronutrients, along with fats and proteins, serving as a source of energy to the body. These biomolecules store energy in the form of glycogen and starch, and play a role in defining the cellular structure (e.g., cellulose). Basics of Carbohydrates to short-chain fatty acids for absorption

Consequences of bowel resection

Several factors determine the degree of intestinal function loss after bowel resection:

  • The length of remaining small bowel after resection:
    • Normal length of the small intestine Small intestine The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum. Small Intestine is 480 cm (190 in).
    • < 180–200 cm (71–79 in) places a patient at very high risk for SBS
  • Segments of small bowel removed:
    • Jejunocolic anastomosis
      • Resection of the entire ileum and ileocecal valve
      • Most common anatomy in SBS
    • Jejunoileocolonic anastomosis:
      • Resection of a portion of the ileum
      • Maintains the ileocecal calve and entire colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix
      • Best prognosis → avoids TPN in many cases
    • End jejunostomy:
      • Resection of ileum, ileocecal valve, and colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix (or colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix is present but disconnected)
      • Worst prognosis → often results in TPN dependence
  • Loss of the ileocecal valve:
    • ↑ In bile acids entering the colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix → stimulates colonic fluid and electrolyte secretion → ↑ diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea
    • Malabsorption Malabsorption Malabsorption involves many disorders in which there is an inability of the gut to absorb nutrients from dietary intake, potentially including water and/or electrolytes. A closely related term, maldigestion is the inability to break down large molecules of food into their smaller constituents. Malabsorption and maldigestion can affect macronutrients (fats, proteins, and carbohydrates), micronutrients (vitamins and minerals), or both. Malabsorption and Maldigestion of vitamin B12
  • Concomitant colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix resection:
    • Colon helps mitigate fluid loss.
    • Loss of the colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix → ↓ adaptive capabilities
Types of bowel resection

Types of bowel resection

Image by Lecturio.
Radiological examinations demonstrated the short bowel syndrome

Radiological examinations demonstrating short bowel syndrome

Image: “Colectomy and acute renal failure: a case report with unusual presentation” by Sahin OZ, Bilir C, Ayaz T. License: CC BY 3.0, edited by Lecturio.

Phases of SBS

Acute phase:

  • Begins immediately following resection or insult to the bowel
  • Lasts 3‒4 weeks
  • Characteristics:
    • ↓ Inhibitory hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview from the terminal ileum → gastric acid hypersecretion
      • ↑ Fluid volume entering the small bowel
      • ↑ Acid load
    • Significant intestinal fluid losses → dehydration and electrolyte deficiencies
    • Poor absorption of all nutrients

Adaptation phase:

  • Begins 2‒4 days after insult to bowel
  • Lasts 1‒2 years
  • Structural and functional changes to the small bowel and colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix occur to maximize absorption.
    • .Jejunum demonstrates some adaptive changes.
      • Functional changes in transport and enzymatic activity
      • Minimal structural changes
    • Ileum is the most capable of adaptation.
      • ↑ In villous length and surface area
      • ↑ Intestinal length and diameter
      • Slowed motility
    • Colonic adaptation
      • ↑ In number of enterocytes
      • Slowed motility
      • ↑ Absorption of fluids → can absorb up to 6 L per day
      • ↑ Carbohydrate reabsorption to maintain approximately 50% of daily energy requirements

Maintenance phase:

  • Permanent
  • Bowel reaches its maximum absorptive capacity.

Clinical Presentation and Diagnosis

General clinical presentation

  • History of bowel resection, inflammatory bowel disease, or radiation
  • Symptoms:
    • Diarrhea
    • Steatorrhea
    • Weight loss
    • Fatigue
    • Heartburn
    • Lower extremity swelling
  • Physical exam findings
    • Dehydration
    • Temporal wasting
    • Loss of muscle mass

Nutritional deficiencies

  • Essential fatty acid deficiency
    • Growth retardation
    • Dermatitis
    • Alopecia Alopecia Alopecia is the loss of hair in areas anywhere on the body where hair normally grows. Alopecia may be defined as scarring or non-scarring, localized or diffuse, congenital or acquired, reversible or permanent, or confined to the scalp or universal; however, alopecia is usually classified using the 1st 3 factors. Alopecia
  • Vitamin A deficiency
    • Xerophthalmia 
      • Abnormal dryness of the conjunctiva and cornea
      • Thickening of the conjunctiva
      • Can lead to corneal ulcerations
      • Eventual night blindness or total blindness
    • Dry, scaly skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin
    • Growth delay
    • Immune system impairment
  • Vitamin D deficiency
    • Poor growth
    • Osteomalacia Osteomalacia Rickets and osteomalacia are disorders of decreased bone mineralization. Osteomalacia affects the sites of bone turnover in children and adults. Although most cases are due to vitamin D deficiency, other genetic and nutritional disorders as well as medications can cause these disorders. Osteomalacia can present with bone pain, difficulty with ambulation and pathologic fractures. Osteomalacia and Rickets
    • Rickets Rickets Rickets and osteomalacia are disorders of decreased bone mineralization. Rickets affects the cartilage of the epiphyseal growth plates in children. Although most cases of rickets are due to vitamin D deficiency, other genetic and nutritional disorders as well as medications can cause these disorders. Rickets commonly presents with skeletal deformities and growth abnormalities. Osteomalacia and Rickets in children
  • Vitamin E deficiency
    • Ataxia
    • Hemolytic anemia Hemolytic Anemia Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia
    • Immunodeficiency
  • Vitamin K deficiency
    • Ecchymoses
    • Bleeding gums
    • Petechia
  • Vitamin B12 deficiency
    • Pernicious anemia
    • Ataxia
    • Paresthesias
  • Mineral deficiencies
    • Copper
    • Zinc
    • Selenium
    • Iron
  • Electrolyte deficiencies
    • Potassium
    • Magnesium
    • Calcium
    • Bicarbonate

Laboratory findings

The following table summarizes possible laboratory findings in SBS that correlate with signs and symptoms of malabsorption.

Manifestation Laboratory findings
Steatorrhea ↑ Fecal fat content
Diarrhea ↑ Stool osmolality
Bleeding, ecchymosis ↑ PT/INR and aPTT
Microcytic anemia ↓ Ferritin and iron
Macrocytic anemia ↓ Vitamin B12 and folic acid
Bone pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, fractures ↓ Calcium and vitamin D
Lactose intolerance Lactose intolerance Lactose intolerance (LI) describes a constellation of symptoms due to lactase deficiency (LD), the enzyme located in the brush border of the absorptive cells in the small intestine. Lactose is the disaccharide present in milk and requires hydrolysis by lactase to break it down into its 2 absorbable constituents, glucose and galactose. Lactose intolerance typically presents with bloating, abdominal cramping, diarrhea, and flatulence. Lactose Intolerance Abnormal lactose tolerance test
Edema ↓ Serum albumin and prealbumin

Management

Acute phase

  • Goal: Stabilize fluid and electrolyte losses.
  • IV fluids and electrolyte replacement
  • Gastric acid suppression
    • Histamine blockers (H2 blockers)
    • Proton pump inhibitors (PPIs)
  • TPN
    • Start once patient is stabilized.
    • Helps maintain hydration
    • Requires close monitoring and adjustments for:
      • Electrolytes
      • Fat
      • Carbohydrates
      • Protein
      • Vitamins
      • Minerals
  • Enteral nutrition
    • Can be done through a nasogastric or gastrostomy feeding tube
    • Should be initiated as soon as possible
    • Goal is to facilitate intestinal adaptation and reduce the need for TPN.

Adaptation phase

  • Slow transition to an oral diet
  • Continue gastric acid suppression for the first 6 months.
  • Antimotility agents to prolong transit time
    • Loperamide (Immodium)
    • Diphenoxylate-atropine (Lomotil)
    • Tincture of opium
  • Decrease GI secretions
    • Octreotide (somatostatin analog) inhibits GI secretions. 
    • Cholestyramine to bind bile acids
  • Teduglutide (Gattex)
    • Analog of glucagon-like peptide 2
    • Promotes small bowel adaptation
    • Used in patients with persistent intestinal failure requiring TPN

Surgical interventions

Intestinal lengthening procedures:

  • Most commonly performed in pediatric populations, rarely in adults
  • Indicated in patients with persistent intestinal failure who meet specific criteria:
    • Dilated small bowel
    • Failure of maximal medical therapy
    • Reasonable chance that length of reconstructed bowel will liberate the patient from TPN dependence
    • No preexisting motility disorders
  • Techniques:
    • Longitudinal intestinal lengthening and tailoring (LILT) procedure
      • Dilated small bowel is transected longitudinally between the mesenteric and antimesenteric border to create parallel segments.
      • Requires multiple small bowel anastomoses
    • Serial transverse enteroplasty procedure (STEP)
      • Increases length and absorptive capacity by tapering dilated bowel
      • No small bowel anastomoses

Transplant:

  • Very rarely performed due to success with medical therapies and lengthening procedures
  • Often done at the same time as solid organ transplant (multivisceral transplantation)
  • Reserved for patients who are dependent on TPN with the following additional complications:
    • Hepatic failure (most common cause of death in SBS)
    • Thrombosis of major central veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins prohibiting central line placement
    • Recurrent catheter-related sepsis Sepsis Organ dysfunction resulting from a dysregulated systemic host response to infection separates sepsis from uncomplicated infection. The etiology is mainly bacterial and pneumonia is the most common known source. Patients commonly present with fever, tachycardia, tachypnea, hypotension, and/or altered mentation. Sepsis and Septic Shock
    • Recurrent, severe dehydration despite TPN

Differential Diagnosis

  • Crohn’s disease: a chronic, recurring condition that causes patchy, transmural inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation involving any part of the GI tract (most commonly terminal ileum and colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix). Patients present with intermittent, non-bloody diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea and crampy abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain. Extraintestinal manifestations may include uveitis Uveitis Uveitis is the inflammation of the uvea, the pigmented middle layer of the eye, which comprises the iris, ciliary body, and choroid. The condition is categorized based on the site of disease; anterior uveitis is the most common. Diseases of the Uvea, gallstones, erythema nodosum Erythema nodosum Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum, and arthritis. Diagnosis is established via endoscopy with biopsy, and management includes corticosteroids, azathioprine, antibiotics, and anti- tumor necrosis factor Tumor necrosis factor Tumor necrosis factor (TNF) is a major cytokine, released primarily by macrophages in response to stimuli. The presence of microbial products and dead cells and injury are among the stimulating factors. This protein belongs to the TNF superfamily, a group of ligands and receptors performing functions in inflammatory response, morphogenesis, and cell proliferation. Tumor Necrosis Factor (TNF) ( TNF TNF Tumor necrosis factor (TNF) is a major cytokine, released primarily by macrophages in response to stimuli. The presence of microbial products and dead cells and injury are among the stimulating factors. This protein belongs to the TNF superfamily, a group of ligands and receptors performing functions in inflammatory response, morphogenesis, and cell proliferation. Tumor Necrosis Factor (TNF)) agents.
  • Celiac disease Celiac disease Celiac disease (also known as celiac sprue or gluten enteropathy) is an autoimmune reaction to gliadin, which is a component of gluten. Celiac disease is closely associated with HLA-DQ2 and HLA-DQ8. The immune response is localized to the proximal small intestine and causes the characteristic histologic findings of villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis. Celiac Disease: an autoimmune reaction to gliadin, a component of gluten. The immune response is localized to the proximal small intestine Small intestine The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum. Small Intestine and causes the characteristic histologic findings of villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis Lymphocytosis WBCs develop from stem cells in the bone marrow and are called leukocytes when circulating in the bloodstream. Lymphocytes are 1 of the 5 subclasses of WBCs. Lymphocytosis is an increase in the number or proportion of the lymphocyte subclass of WBCs, often as a result of an immune response to infection (known as reactive lymphocytosis). Lymphocytosis. Patients present with diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea and symptoms related to malabsorption (steatorrhea, weight loss, and nutritional deficiencies). Diagnosis is made by serological antibody testing and confirmed by small intestine Small intestine The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum. Small Intestine biopsy. Management requires a lifelong gluten-free diet.
  • Necrotizing enterocolitis Necrotizing enterocolitis Necrotizing enterocolitis (NEC) is an intestinal inflammatory process that can lead to mucosal injury and necrosis. The condition is multifactorial, with underlying risk factors that include prematurity and formula feeding. The clinical presentation varies in severity from feeding intolerance, acute findings on abdominal exam, and systemic symptoms. Necrotizing Enterocolitis: most commonly occurs in premature infants who are formula-fed and is characterized by ischemic necrosis of the intestinal mucosa. Individuals present with abdominal distention, vomiting, abdominal tenderness, and rectal bleeding. The diagnosis is primarily made with imaging, such as abdominal X-ray or ultrasound. Treatment options consist of conservative management with bowel rest and antibiotics, or surgery in cases of known or suspected necrosis with perforation.
  • Small intestinal bacterial overgrowth: occurs when aerobic and anaerobic microbes normally present in the colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix grow excessively in the small intestine Small intestine The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum. Small Intestine. More than 90% of cases are due to motility disorders and chronic pancreatitis Chronic pancreatitis Chronic pancreatitis is due to persistent inflammation, fibrosis, and irreversible cell damage to the pancreas, resulting in a loss of endocrine and exocrine gland function. The most common etiologies are alcohol abuse and pancreatic duct obstruction. Patients often present with recurrent epigastric abdominal pain, nausea, and features of malabsorption syndrome (diarrhea, steatorrhea, and weight loss). Chronic Pancreatitis. Patients present with bloating, flatulence, watery diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea, and abdominal discomfort. The diagnosis can be made with breath testing. The mainstay of treatment is antibiotics and correction of nutritional deficiencies.

References

  1. DiBaise, J.K. (2020). Management of the short bowel syndrome in adults. In Grover, S. (Ed.), UpToDate. Retrieved February 20, 2021, from https://www.uptodate.com/contents/management-of-the-short-bowel-syndrome-in-adults
  2. Cagir, B. (2021). Short-Bowel Syndrome. In Geibel, J. (Ed.), Medscape. Retrieved February 20, 2021, from https://emedicine.medscape.com/article/193391-overview
  3. DiBaise, J.K. (2020). Pathophysiology of short bowel syndrome. In Hoppin, A.G. (Ed.), UpToDate. Retrieved February 21, 2021, from https://www.uptodate.com/contents/pathophysiology-of-short-bowel-syndrome
  4. Khanm F.A., Selvaggi, G. (2020). Overview of intestinal and multivisceral transplantation. In Robson, K.M. (Ed.), UpToDate. Retrieved February 21, 2021, from https://www.uptodate.com/contents/overview-of-intestinal-and-multivisceral-transplantation
  5. Stamm, D.A., Duggan, C. (2020). Management of short bowel syndrome in children. In Hoppin, A.G. (Ed.), UpToDate. Retrieved February 21, 2021, from https://www.uptodate.com/contents/management-of-short-bowel-syndrome-in-children
  6. Kim, J.H. (2020). Neonatal necrotizing enterocolitis: Clinical features and diagnosis. In Kim, M.S. (Ed.), UpToDate. Retrieved February 21, 20210, from https://www.uptodate.com/contents/neonatal-necrotizing-enterocolitis-clinical-features-and-diagnosis
  7. Pimental, M. (2020). Small intestinal bacterial overgrowth: Management. In Grover, S. (Ed.), UpToDate. Retrieved February 21, 2021, from https://www.uptodate.com/contents/small-intestinal-bacterial-overgrowth-management
  8. Ruiz, Jr., A.R. (2021). Short bowel syndrome. MSD Manual Professional Version. Retrieved February 23, 2021, from https://www.msdmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/short-bowel-syndrome

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