Short Gut Syndrome
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Introduction
Short gut syndrome, or short bowel syndrome, is defined by the inability to survive without parental nutrition.
50 cm in full-term baby and approximately 3 feet (1m) in an adult.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
One of the commonest causes in children is surgery for gastroschisis or omphalocele.
Other surgeries for
- necrotizing enterocolitis
- Hirschprungs
Pathophysiology
Baby's guts can grow in length, while adults only hypertrophy
Nutrient intake is related to total length, presence of colon (water absorption, carbohydrate salvage), and presence of ileocecal valve (regulates forward flow and prevents bacterial backflow)
Problems are related to nutrition/feeding and to TPN.
TPN-related
- sepsis (from IV line)
- cholestasis and liver disease
Nutrition-related
- decreased motility can lead to small bowel overgrowth
Reflux can result from gut stasis
The psychosocial impact of short-gut syndrome, and its lengthy required hopsitalization, can be enormous for families. TPN can be delivered at home, but this is highly dependent on family motivation and preparedness.
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Increase gut transit time with loperamide.
Consequences and Course
Resources and References
Topic Development
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