Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- perda de peso
- diarreia
- depleção de volume
- edema periférico ou pré-sacral
Other diagnostic factors
- fadiga
- dor epigástrica pós-prandial ou dor abdominal no quadrante superior direito
- disúria ou cólica renal
- exame neurológico anormal
- icterícia e prurido
- sinais dermatológicos
- cegueira noturna
- fraqueza motora ou marcha alterada
- fraqueza muscular proximal
- sangramento excessivo
- confusão
Risk factors
- ressecção do intestino
- lesão por radiação abdominal extensa
- gastrosquise
Diagnostic tests
1st tests to order
- Hemograma completo
- eletrólitos séricos
- ureia e creatinina séricas
- albumina sérica
- cálcio, zinco, selênio e folato séricos
- vitaminas A, B1, B2, B6, B12, C, D e E
- ácido metilmalônico (AMM)
- razão normalizada internacional (INR)
Tests to consider
- aminotransferases hepáticas séricas, fosfatase alcalina e bilirrubina (total e direta)
- análise da urina
- D-lactato sérico
- quantificação da gordura fecal
- séries do trato gastrointestinal superior com contraste
- Exame de absorciometria por dupla emissão de raios X (DEXA)
- ultrassonografia abdominal
- tomografia computadorizada (TC) abdominal
Treatment algorithm
anastomose jejunoileocólica
anastomose jejunoileal com ressecção total do cólon
jejunostomia terminal ou duodenostomia
todos os pacientes
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.
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003 Apr;124(4):1111-34.Full text Abstract
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.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Doença de Crohn ativa
- Doença celíaca
- Malignidade do intestino delgado
More DifferentialsGuidelines
- ESPEN guidelines on clinical nutrition in chronic intestinal failure
- ESPEN guidelines on home parenteral nutrition
More Guidelines
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