Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- weight loss
- diarrhoea
- volume depletion
- peripheral or pre-sacral oedema
Other diagnostic factors
- fatigue
- post-prandial epigastric or right upper quadrant abdominal pain
- dysuria or renal colic
- abnormal neurological examination
- jaundice and pruritus
- dermatological 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
- FBC
- serum electrolytes
- serum urea 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
- faecal 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.
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.
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.
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. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Active Crohn's disease
- Coeliac disease
- Small bowel malignancy
More DifferentialsGuidelines
- ESPEN guidelines on clinical nutrition in chronic intestinal failure
- ESPEN guidelines on home parenteral nutrition
More Guidelines
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