Summary
Definition
History and exam
Key diagnostic factors
- weight loss
- diarrhea
- volume depletion
- peripheral or presacral edema
Other diagnostic factors
- fatigue
- fractures
- 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 investigations
1st investigations 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
Investigations 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

Visiting Professor of Clinical Surgery and Medical Director of the Intestinal Transplant and Rehabilitation Center
University of Illinois at Chicago
Medical Director
Health Care Services Corporation
Chicago
IL
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
Douglas Seidner, MD
Associate Professor of Medicine
Division of Gastroenterology, Hepatology and Nutrition
Director
Vanderbilt Center for Human Nutrition
Vanderbilt University Medical Center
Nashville
TN
Disclosures
DS has been an advisor for B. Braun and Baxter Healthcare; has received lecture fees from Coram Healthcare, EMD Serono, and Nutrishare; has prepared a newsletter for Mayne Pharma; and has received research funding from Baxter Healthcare and NPS Pharmaceutical.
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 chronic intestinal failure in adults
- ESPEN endorsed recommendations: definition and classification of intestinal failure in adults
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