Short bowel syndrome
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- weight loss
- diarrhea
- volume depletion
- peripheral or presacral edema
Otros factores de diagnóstico
- 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
Factores de riesgo
- bowel resection
- extensive abdominal radiation injury
- gastroschisis
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- 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
Pruebas diagnósticas que deben considerarse
- 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
Algoritmo de tratamiento
jejunoileocolic anastomosis
jejunoileal anastomosis with fully resected colon
end jejunostomy or duodenostomy
all patients
Colaboradores
Autores
Alan Buchman, MD, MSPH, FACP, FACG, FACN, AGAF
Medical Director, Gastroenterology
Anthem Health
Indianapolis
IN
Divulgaciones
AB is an author of references cited in this topic.
Agradecimientos
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 por pares
Marian F. Winkler, PhD RD
Professor of Surgery
Surgical Nutrition Specialist
Alpert Medical School of Brown University and Rhode Island Hospital
Providence
RI
Divulgaciones
MFW declares that she has no competing interests.
Jonathan Shaffer, MBBS
Hospital Dean
Intestinal Failure Unit
Hope Hospital
Salford
Manchester
UK
Divulgaciones
Not disclosed. JS is the author of references cited in this topic.
Agradecimiento de los revisores por pares
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Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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 Resumen
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 Resumen
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. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Differentials
- Active Crohn disease
- Celiac disease
- Small bowel malignancy
Más DifferentialsGuidelines
- ESPEN guidelines on clinical nutrition in chronic intestinal failure
- ESPEN guidelines on home parenteral nutrition
Más Guidelines
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