If a significant portion or all of the jejunum is resected, the absorption of proteins, carbohydrates, and most vitamins and minerals can be unaffected because of adaptation in the ileum. BUT unfortunately, enzymatic digestion suffers because of the irreplaceable loss of enteric hormones produced by the jejunum. ALSO, gastrin levels rise, causing gastric hypersecretion. The high acid output from the stomach injure the SI mucosa. JEJUNUM
In addition, the TI is the site of absorption of bile salts and vitamin B-12. Continued loss of bile salts leads to fat malabsorption, steatorrhea, and loss of fat-soluble vitamins. Ileal resection severely decreases the capacity to absorb water and electrolytes. ILEUM Peptide YY, released from L cells in the distal ileum and colon, slows gastric emptying and intestinal transit. In the event of distal ileal and colonic resection, this feedback inhibition is lost.
Retention of the ileocecal valve plays a pivotal role in massive small bowel resection. If the ileocecal valve is lost, transit time is faster, and loss of fluid and nutrients is greater. Furthermore, colonic bacteria can colonize the small bowel, worsening diarrhea and nutrient loss. ILEOCECAL VALVE
Preservation of the colon has positive and negative attributes. Increasing colonic water absorption as much as 5 times its normal capacity. Resident bacteria capacity to metabolize undigested CHO into SCFA. These are a preferred fuel source for the coloncytes & body. Increasing the incidence of urinary calcium oxalate stone formation. Small intestinal bacterial overgrowth. COLON NEGATIVE POSITIVE
Most patients require TPN at least initially. Enteral feeding should be gradually introduced once ileus has resolved.
Macro and micronutrients
Drugs ; PPI, Antimotilty agents
Medication malabsorption could occur, therefore, increased doses of orally administered medication is required.
HOME PN Unfortunately, some patients are extremely difficult or impossible to wean from parenteral nutritionand and maintained on “home PN or HPN” HOME PN Common characteristics of these patients: Very short remaining small bowel segments (<60 cm), Loss of the colon, Loss of the ileocecal valve, or Small bowel strictures with stasis and bacterial overgrowth.
Longitudinal intestinal lengthening and tailoring procedure especially in pediatric patients with dilated small bowel.
Serial Transverse Enteroplasty (STEP) NEW SURGERY described just three years ago, can both lengthen and taper the small intestine in some patients. During the procedure, a short segment of the intestine is carefully cut and reshaped into a longer, thinner segment. The longer, thinner intestine is thought to function more efficiently and lead to better absorption of food.
Combined intestine-liver transplantation Isolated intestinal transplantation Is the only alternative for patients who have developed end-stage liver disease related to SBS or long-term TPN therapy. Considered for patients with significant liver disease that has not yet progressed to cirrhosis. B. INTESTINAL TRANSPLANTATION Also, for those with significant fluid losses and who have episodes of frequent, severe dehydration despite appropriate medical management.