Management of patients with a short bowel.
There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good.
Nightingale
J M
JM
Gastroenterology Centre, Leicester Royal Infirmary, United Kingdom. jnightingale@uhl.trent.nhs.uk
D003106:Colon / Q000503:physiopathology; D004064:Digestive System / Q000503:physiopathology; D006801:Humans; D007582:Jejunostomy; D009748:Nutrition Disorders / Q000209:etiology; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*