Last reviewed: 30 Sep 2024
Last updated: 29 Jun 2022
Summary
Definition
History and exam
Key diagnostic factors
- weight loss
- diarrhea
- volume depletion
- peripheral or presacral edema
Full details
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
Full details
Risk factors
- bowel resection
- extensive abdominal radiation injury
- gastroschisis
Full details
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
Full details
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
Full details
Treatment algorithm
ACUTE
jejunoileocolic anastomosis
jejunoileal anastomosis with fully resected colon
end jejunostomy or duodenostomy
ONGOING
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.
Peer reviewers
Marian F. Winkler, PhD RD
Professor of Surgery
Surgical Nutrition Specialist
Alpert Medical School of Brown University and Rhode Island Hospital
Providence
RI
Disclosures
MFW declares that she has no competing interests.
Jonathan Shaffer, MBBS
Hospital Dean
Intestinal Failure Unit
Hope Hospital
Salford
Manchester
UK
Disclosures
Not disclosed. JS is the author of references cited in this topic.
Differentials
- Active Crohn disease
- Celiac disease
- Small bowel malignancy
More DifferentialsGuidelines
- ESPEN guidelines on clinical nutrition in chronic intestinal failure
- ESPEN guidelines on home parenteral nutrition
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