Small bowel resection

Small bowel resection, severe diarrhea, intractable vomiting, bowel obstruction, and fistulas ° Critically ill patients with nonfunctioning GI tract... 

Major small bowel resection (e.g., short bowel syndrome)... 

AA is 45-year-old woman admitted to the hospital with chief complaints of fever, abdominal pain, nausea, and vomiting for 2 days. She also reports decreased appetite and decreased oral intake for the past 3 to 4 days. The patient was discharged 2 weeks ago after having a small bowel resection for recurrent bowel obstruction. 

Small bowel resections (greater than 100 cm of small intestine remaining, colon intact)... 

In May 2008, the U.S. Food and Drug Administration (FDA) approved 3 for accelerating the time to upper and lower gastrointestinal recovery following partial large or small bowel resection with primary anastomosis. 

Parenteral therapy should be reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and for patients with extensive chronic anemia who cannot be maintained with oral iron alone. This includes patients with advanced chronic renal disease requiring hemodialysis and treatment with erythropoietin, various postgastrectomy conditions and previous small bowel resection, inflammatory bowel disease involving the proximal small bowel, and malabsorption syndromes. 

The most common causes of vitamin B12 deficiency are pernicious anemia, partial or total gastrectomy, and conditions that affect the distal ileum, such as malabsorption syndromes, inflammatory bowel disease, or small bowel resection. 

In a study of vitamin B12 levels in 835 consecutive psychiatric patients, Elsborg et al. (E6) found a reduced serum concentration in 10%. Of these 1 patient had pernicious anemia, 7 were postgastrectomy, and 1 had previously had a small bowel resection the remaining 72 patients were considered to have a nutritional deficiency. 

Koruda, M, J., Rolandelli, R. H., Settle, ft. G., immaro, D- M., and Rombeau, J. L. (1988 -Effecl of parenteral nutrition supplemented with short-chain fatty acids on adaptation to massive small bowel resection. Gaslrwnierology 95, 715-720. 

This unusual form of lactic acidosis is due to increased production and accumulation of D-lactate in circulation. The normal isomer synthesized in the human body is L-lactate but the D-lactate isomer can occur in patients with jejunoileal bypass, small bowel resection, or other types of short bowel syndrome. In these patients, ingested starch and glucose bypass the normal metabolism in the small intestine and lead to increased delivery of nutrients to the colon where gram-positive, anaerobic bacteria (e.g., Lactobacilli) ferment glucose to D-lactate. The D-lactate is absorbed via the portal circulation. 

Barsoum GH, Thompson J, Neoptolemos JP, et al. 1992. Dietary calcium does not reduce experimental colorectal carcinogenesis after small bowel resection despite reducing cellular proliferation. Gut 33 1515-1520. 

Proper nutritional support is an important aspect of the treatment of patients with IBD, not because specific types of diets are useful in alleviating the inflammatory conditions, but because patients with moderate to severe disease are often malnourished either because the inflammatory process results in significant malabsorption or maldigestion, or because of the catabolic effects of the disease process. Malabsorption may occur in the patient with Crohn s disease with inflammatory involvement of the small bowel, where many nutrients are absorbed, as well as in patients who have undergone multiple small bowel resections with subsequent reduction in absorptive surface ( short gut ). Maldigestion can occur if there is a bile salt deficiency in the gut. 

Because alvimopan reverses the adverse effects of opioids on the gastrointestinal tract, it accelerates gastrointestinal recovery in patients following colorectal or small-bowel resection surgery. This potentially improves patient comfort while reducing healthcare expenditure due to extended hospitalization. 

Its occurrence of the crypts of small bowel and colon after partial small bowel resection, Arch.Surg., 115 1481-1485 (1980). 

Jeppesen, RB. and Mortensen, RB. The influence of apreserved colon on the absorption of medium chain fatty acids in patients with small bowel resection. Gut 43,... 

---