Sandbox: wdx causes: Difference between revisions

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Short bowel syndrome is the result of [[bowel resection]] following various causes including [[Crohn's disease]], [[Cancer|malignancies]], [[ischemia]], and [[Physical trauma|trauma]]. The [[small intestine]] less than 2 meters is considered as short bowel syndrome and requires [[Nutrition|nutritional]] therapy to prevent [[malnutrition]]. Post bowel resection adaptation might occur which includes structural, motility and functional changes in the remaining [[intestine]]. Changes usually start in the first 24 hours following [[bowel resection]] and last for about two years. [[Adaptation]] depends on multiple factors including individual, [[Intestine|intestinal]] and [[Therapy|therapeutic]] measurements. Successful [[adaptation]] depends on the length of remaining [[intestine]], portion of the resected [[intestine]], and early introduction of [[nutrition]] therapy. Total [[Intestine|intestinal]] [[adaptation]] defines as when patient is weaned from [[Total parenteral nutrition|parenteral nutrition]].
! colspan="4" |Intestinal adaptation
|-
!Phase
!Duration
!Main feature
!Management
|-
!'''Acute phase'''
|1 to 3 months
|
* [[Hypovolemia|Fluid loss]]
* Poor [[absorption]] of all [[Nutrient|nutrients]], including [[Carbohydrate|carbohydrates]], [[Protein|proteins]], [[fat]], [[Electrolyte|electrolytes]], [[Mineral|minerals]] and trace elements
* Dysmotility
* Hypergastrinemia
|
* Administration percutaneous [[central venous catheter]]
* Aggressive [[fluid]] and [[Electrolyte disturbance|electrolyte]] replacement 
* Cyclical [[Total parenteral nutrition|parenteral nutrition]] (overnight feeding)
* [[Intravenous therapy|Intravenous]] administration of [[Proton pump inhibitor|proton pump inhibitors]] or [[H2 antagonist|H2 receptor blockers]]
* Prophylactic [[Antibiotic|oral antibiotics]] such as [[neomycin]] and [[metronidazole]]
* Prophylaxis with [[cholecystokinin]]
* Frequent measurements of [[vital signs]], intake and output, and [[central venous pressure]]
|-
!'''Adaptive phase'''
|1 to 2 years
|
* Reaching 90% to 95% of the bowel [[adaptation]] potential
* [[Enterocyte]] and [[Villous folds|villous]] [[hyperplasia]]
* Increased [[Mucous membrane|mucosal]] surface area
* Converting unabsorbed [[Carbohydrate|carbohydrates]] into absorbable [[short-chain fatty acids]]
* Gaining weight
* Stabilization of [[fluid]] and [[electrolyte]] levels
|
* [[Total parenteral nutrition]]
* Initiating [[Feeding tube|enteral feeding]] 
* Adding [[Trophic hormone|trophic factors]]
|-
!'''Maintenance phase'''
|Following adaptive phase
|
* Reaching the maximum bowel [[adaptation]] potential
|
* Individualized permanent [[nutrition]] treatment
* Oral [[nutrition]]
|}

Revision as of 17:26, 13 December 2017

Short bowel syndrome is the result of bowel resection following various causes including Crohn's disease, malignancies, ischemia, and trauma. The small intestine less than 2 meters is considered as short bowel syndrome and requires nutritional therapy to prevent malnutrition. Post bowel resection adaptation might occur which includes structural, motility and functional changes in the remaining intestine. Changes usually start in the first 24 hours following bowel resection and last for about two years. Adaptation depends on multiple factors including individual, intestinal and therapeutic measurements. Successful adaptation depends on the length of remaining intestine, portion of the resected intestine, and early introduction of nutrition therapy. Total intestinal adaptation defines as when patient is weaned from parenteral nutrition.

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