Difference between revisions of "Short Bowel Syndrome"
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==Description== | ==Description== | ||
| − | Short bowel syndrome occurs when greater than 75-90% of small intestine is absent. It is most commonly caused by iatrogenic surgical resection, although congenital anomaly can occur. The remaining small intestine cannot adequately absorb nutrients and electrolytes, resulting in diarrhoea. If the ileocolic valve has been removed, a large number of bacteria is more likely to reach the small intestine. | + | Short bowel syndrome occurs when greater than 75-90% of small intestine is absent. It is most commonly caused by iatrogenic surgical resection, although congenital anomaly can occur in rare cases. The remaining small intestine cannot adequately absorb nutrients and electrolytes, resulting in diarrhoea. If the ileocolic valve has been removed, a large number of bacteria is more likely to reach the small intestine. A large resection of the small intestine may result in changes in gastrointestinal hormone re=gulation such as hypergastrinaemia and increased acid secretion. |
| − | This syndrome should ideally be avoided in the first instance. It is may be better to perform a second surgery 24-48 hours after the first surgery in order to avoid a large resection of the small intestine. | + | This syndrome may only be transient until the remaining of the intestine can undergo adaptive hyperplasia. It does not necesary occur in all cases which have undergone intestinal resection. This should ideally be avoided in the first instance. It is may be better to perform a second surgery 24-48 hours after the first surgery in order to avoid a large resection of the small intestine. |
| Line 20: | Line 20: | ||
==Treatment== | ==Treatment== | ||
| + | ===Nutritional support=== | ||
| + | *Total or partial parenteral nutrition may be required in some cases to provide adequate nutrition until adaptive hyperplasia takes place. | ||
| + | *At the same time, it is important to continue oral feeding to stimulate mucosal hypertrophy. | ||
| + | |||
===Dietary modification=== | ===Dietary modification=== | ||
*Small, frequent meals of highly digestible, low fat diet is recommended. | *Small, frequent meals of highly digestible, low fat diet is recommended. | ||
| Line 29: | Line 33: | ||
===Antisecretory agents & antacids=== | ===Antisecretory agents & antacids=== | ||
| − | *These may be needed in cases which are poorly responsive to lessen diarrhoea and gastric hypersecretion. | + | *These may be needed in cases which are poorly responsive diet and antimicrobials alone. Its aim is to lessen diarrhoea and gastric hypersecretion. |
*Antisecretory agents such as loperamide, diphenoxylate. | *Antisecretory agents such as loperamide, diphenoxylate. | ||
*Antacids such as ranitidine, famotidine. | *Antacids such as ranitidine, famotidine. | ||
| − | + | ||
| − | |||
| − | |||
==Prognosis== | ==Prognosis== | ||
| − | This is dependent on the length of the small intestine | + | This is dependent on the length of the small intestine left and response to therapy. If adequate adaption occurs, the patient may respond well and eventually be ablet to consume near-normal diet. However, there will always be a limitation in the absoptive capacity of these animals. Some cases may respond poorly and can never be fed on a normal diet or some may die. Malnourished animals have a poorer prognosis. |
Revision as of 08:53, 18 August 2009
 |
This article is still under construction. |
Description
Short bowel syndrome occurs when greater than 75-90% of small intestine is absent. It is most commonly caused by iatrogenic surgical resection, although congenital anomaly can occur in rare cases. The remaining small intestine cannot adequately absorb nutrients and electrolytes, resulting in diarrhoea. If the ileocolic valve has been removed, a large number of bacteria is more likely to reach the small intestine. A large resection of the small intestine may result in changes in gastrointestinal hormone re=gulation such as hypergastrinaemia and increased acid secretion.
This syndrome may only be transient until the remaining of the intestine can undergo adaptive hyperplasia. It does not necesary occur in all cases which have undergone intestinal resection. This should ideally be avoided in the first instance. It is may be better to perform a second surgery 24-48 hours after the first surgery in order to avoid a large resection of the small intestine.
Diagnosis
Clinical Signs
- Small intestinal diarrhoea, often with udigested food particles in the faeces
- Severe weight loss
In cases which occur after surgical bowel resection, the presenting clinical signs is sufficient to make a diagnosis. In cases of congenital origin, a plain or contrast radiography is required.
Treatment
Nutritional support
- Total or partial parenteral nutrition may be required in some cases to provide adequate nutrition until adaptive hyperplasia takes place.
- At the same time, it is important to continue oral feeding to stimulate mucosal hypertrophy.
Dietary modification
- Small, frequent meals of highly digestible, low fat diet is recommended.
- Vitamin supplementation may be required.
Antimicrobials
- A secondary antibiotic responsive diarrhoea may result if the ileocaecal valve is removed.
- Metronidazole or tylosin can be given in these cases.
Antisecretory agents & antacids
- These may be needed in cases which are poorly responsive diet and antimicrobials alone. Its aim is to lessen diarrhoea and gastric hypersecretion.
- Antisecretory agents such as loperamide, diphenoxylate.
- Antacids such as ranitidine, famotidine.
Prognosis
This is dependent on the length of the small intestine left and response to therapy. If adequate adaption occurs, the patient may respond well and eventually be ablet to consume near-normal diet. However, there will always be a limitation in the absoptive capacity of these animals. Some cases may respond poorly and can never be fed on a normal diet or some may die. Malnourished animals have a poorer prognosis.
References
- Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
- Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
- Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.