Summary
Definition
History and exam
Key diagnostic factors
- weight loss
- diarrhea
- volume depletion
- peripheral or presacral edema
Other diagnostic factors
- fatigue
- postprandial epigastric or right upper quadrant abdominal pain
- dysuria or renal colic
- abnormal neurologic examination
- jaundice and pruritus
- dermatologic signs
- night blindness
- motor weakness or altered gait
- proximal muscle weakness
- excessive bleeding
- confusion
Risk factors
- bowel resection
- extensive abdominal radiation injury
- gastroschisis
Diagnostic tests
1st tests to order
- CBC
- serum electrolytes
- BUN and creatinine
- serum albumin
- serum calcium, zinc, selenium, folate
- vitamins A, B1, B2, B6, B12, C, D, and E
- methylmalonic acid (MMA)
- INR
Tests to consider
- serum hepatic aminotransferases, alkaline phosphatase, and bilirubin (total and direct)
- urine analysis
- serum D-lactate
- fecal fat quantification
- upper gastrointestinal contrast series
- Dual-energy x-ray absorptiometry (DXA) scan
- abdominal ultrasound
- CT abdomen
Treatment algorithm
jejunoileocolic anastomosis
jejunoileal anastomosis with fully resected colon
end jejunostomy or duodenostomy
all patients
Contributors
Authors
Alan Buchman, MD, MSPH, FACP, FACG, FACN, AGAF
Medical Director, Gastroenterology
Anthem Health
Indianapolis
IN
Disclosures
AB is an author of references cited in this topic.
Acknowledgements
Dr Alan Buchman would like to gratefully acknowledge Dr Michael Roth, a previous contributor to this topic. MR is an author of a reference cited in this topic.
Revisores
Marian F. Winkler, PhD RD
Professor of Surgery
Surgical Nutrition Specialist
Alpert Medical School of Brown University and Rhode Island Hospital
Providence
RI
Declarações
MFW declares that she has no competing interests.
Jonathan Shaffer, MBBS
Hospital Dean
Intestinal Failure Unit
Hope Hospital
Salford
Manchester
UK
Declarações
Not disclosed. JS is the author of references cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Pironi L, Arends J, Baxter J, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015 Apr;34(2):171-80.Texto completo Resumo
Cuerda C, Pironi L, Arends J, et al. ESPEN practical guideline: clinical nutrition in chronic intestinal failure. Clin Nutr. 2021 Sep;40(9):5196-220.Texto completo Resumo
Buchman AL. Short bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's gastrointestinal and liver disease. 11th ed. Philadelphia, PA: Saunders; 2020.
Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003 Apr;124(4):1111-34.Texto completo Resumo
Nightingale JM, Lennard-Jones JE, Gertner DJ, et al. Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gallstones in patients with a short bowel. Gut. 1992 Nov;33(11):1493-7. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Active Crohn disease
- Celiac disease
- Small bowel malignancy
Mais Diagnósticos diferenciaisDiretrizes
- ESPEN guidelines on clinical nutrition in chronic intestinal failure
- ESPEN guidelines on home parenteral nutrition
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