1. loss of
1.1. Jejenum
1.1.1. ostmostic diarrhea
1.1.2. reduced dissacharidase activity pull sugar into water
1.2. ileium
1.2.1. increase intestical fluid
1.2.2. decrease transit time
1.3. terminal ileum
1.3.1. watery diarrhea
1.3.2. non absorbed bile acids irritate the colonic muscosa
1.4. Colon
1.4.1. loss of fluid absorption
1.5. ileocecal valve
1.5.1. prolong transit time
1.5.2. increases the duration of contact of intesticnal contents and absorptive surface
1.5.3. acts as barrier to prevent the reflux and overgrowtn of colonic microbes in ileus
2. Complication of SBS
2.1. Diarrhea
2.1.1. loss of intestinal surface area
2.1.2. disordered transit time
2.1.3. inability concentrate the intestinal contents, dehydration hypokalemia, and hypomagnesium
2.2. Bacterial Overgrowth
2.2.1. signs increased diarrhea and pain and bloating, or when there is period of poor weight gain
2.2.2. most frequently occus in absence of ileocecal vlave and dysmotility of stasis occurs in the remaining bowel loops
2.2.3. Can cause fermentation of CHO to D lactate can have neurologic sumptoms r/r metabolic acidosis i
2.3. Cholestasis and liver failure
2.3.1. prolonges use of TPN in infants and children
2.3.2. causing bile sludging gallstones and evenutally liver failure
2.3.3. Early introduction of enteral feeds, even in very small amounts can have a protective effect on hepatic function
2.4. Sepsis
2.4.1. Central Venous Line sepsis
2.4.2. skin or stool contaminates
2.4.3. combination of bacteria overgrowth and gut permeability allows for a seeding of the time from the blood stream
2.5. Gastric hyper-secretion
2.5.1. gastric hypersecretion appears to be proportional to the length of small bowel resected
2.5.2. the lowereed intraduodenal pH activates pancreatic enzymes and stimulates peristalsis
3. Intestinal adaptation
3.1. Endteral feeds even small amounts stimulate bowel growth and adaption
3.1.1. loose ileum not good
3.2. Adieaute adaptation is required for weaning off TPN
3.3. This process characterized by mucosal hyperplasia, vi,lus lengthening increase crypt depth and bowel dilation
3.4. process of structural intesintal enlargement and improvement oin function
4. Definition
4.1. intestinal failure can be defined as the failure of the GI tract to absorb nutrient in order to sustain normal growth and development
4.2. Short bowel syndrome is a form of intestinal failure due to extensive small bowel resection
4.3. Use to be called SBS not is called intestinal Failure
5. Causes
5.1. NEC
5.2. Atresia
5.3. Volvulus
5.4. Gastroschisis
5.5. Hirschsprung's disease
5.6. other
6. Medical Management
6.1. Treat bacterial overgrowth
6.1.1. Oral metronidazole other antibiotics
6.1.1.1. occasionally may re colonize with good bacteria lactobacillius
6.1.1.2. staggered dosage schedules
6.2. Treate gastric hypersecretion
6.3. Decrease bile acid induced diarrhea
6.4. Decrease intestinal motility and output
6.4.1. Paregone
6.4.2. loperamide
6.4.3. output
6.4.3.1. inhibits secretion of gastrin, vasoactive intestinal peptide, SECRETIN, motilin, pancreatic polypeptide, insluin glucagon, serontonin
6.4.3.2. somatostatin
6.4.3.3. decrease bile acid induce diarrheah motility
6.4.3.3.1. cholestyramine
6.5. Enteral Nutrition
6.6. TPN
6.6.1. introduction of continuous enteral feeds, gradually increasing in strength and volume as tolerated
6.6.2. want to wean off as fast as can to protect liver
6.6.3. Gradual process
6.6.3.1. usually takes years
6.6.4. weaning of TPN to cycled
6.7. Fluid/Electrolyte post surgery
6.8. Surgeries
6.8.1. Bianchi
6.8.1.1. bowel lengthening procedure
6.8.1.1.1. various procedure to prolong transit tiem
6.8.1.1.2. ssome questions as to benefit
6.8.1.2. dilate intestine and split 1/2 put it end to end
6.8.2. Step procedure
6.8.2.1. cuts to make with staples to make an accordian affect- done to lengthe the bowel increase SA for absopriton
6.8.3. Small bowel or Liver transplant
6.8.3.1. trading one complex chronic medical illness for another