This document discusses short bowel syndrome, which is caused by a shortage of the small intestine due to various conditions. It can lead to malabsorption, diarrhea, malnutrition, and electrolyte imbalances. The main causes are resection of over half of the small intestine or loss of mucosal function. Management involves controlling fluid loss, diarrhea, and providing nutritional support through total parenteral nutrition or enteral feeds. Surgical techniques and intestinal transplantation may also be used in severe cases. The condition progresses through acute, adaptation, and maintenance phases as the remaining intestine adapts to increase absorption over time.

1. SHORT BOWEL SYNDROME
DR.E.V.DURGA NEELIMA
UNDER GUIDANCE OF DR.R.BHAVANIRAO

2. SHORT BOWEL SYNDROME =SHORTAGE OF
SMALL INTESTINE

3. WHAT DEFINES ?
CLINICAL SYNDROME
• MALABSORPTION
• DIARRHEOA
• MALNUTRITION
• ELECTROLYTE AND FLUID IMBALANCE

4. WHAT CAUSES IT?
• REMANENT SMALL BOWEL LENGTH <200CM.
• FUNCTIONAL LOSS OF SMALL BOWEL MUCOSA UPTO 50%

5. MAIN ETIOLOGICAL FACTORS
ADULTS
• MOST COMMON CAUSE IS
MESENTRIC ISCHEMIA
• NEOPLASTIC DISEASES
• MOTILITY DISORDERS
• CROHNS DISEASE
• RADIATION ENTERITIS
CHILDREN
• NECROTISING ENTEROCOLITIS
• SMALL INTESTINAL ATRESIA
• MIDGUT VOLVULUS

6. ANTOMICAL ASPECTS
• DUODENUM –DUAL BLOOD SUPPLY BOTH FROM CELIAC BRANCHES AND
SUPERIOR MESENTIC ARTERY
• JEJUNUM AND ILEUM –COMPLETELY SUPPLEID BY SUPERIOR MESENTRIC ARTERY

7. PHYSIOLOGICAL ASPECTS
• JEJUNUM: 80% WATER ABSORPTION OCCURS IN THE JEJUNUM.
• PRINICPLE ORGAN FOR DIGESTION AND ABSORPTION OF CARBOHYDRATES ,
PROTIENS MANY MICRO AND MACRO NURTIENTS. VIT B,C, AND FOLIC ACID
• FAT SOLUBLE VITAMINS LIKE A,D,E,K.
• PRODUCES MANY ENTERIC HORMONES WHICH ARE RESPONSIBLE FOR BILLIARY
AND PANCREATIC SECRETIONS.

8. • ILEUM APART FROM ABSORPTION OF WATER AND ELECTROLYTES TERMINAL
ILEUM IS THE SITE FOR ABSORPTION OF BILE SALTS AND VITAMIN B_12
• ILOCEACAL VALVE : INCREASEAS THE TRANSIT TIME OF BOWEL CONTENTS
PREVENTS COLONIC BACTERIA TO COLONISE SMALL INTESTINE

10. • THE PHYSILOGICAL CHANGES AND ADAPTATIONS OCCURS IN THREE PHASES
• ACUTE PHASE
• ADPATION PHASE
• MAINTAINANCE PHASE

11. ACUTE PHASE
• STARTS IMMEDIATELY LAST UPTO 1-2 MONTHS
• LOSS OF GI FLUIDS UPTO 5L/DAY
• LIFE THEATENING FLUID AND ELECTROLYTE IMBALANCE LEADING TO
DEHYDRATION
• EXTREMELY POOR ABSORPTION OF NUTRIENTS
• DEVELOPMENT OF HYPER GASTRENEMIA AND HYPER BILIRUBINEMIA

12. ADAPTATION PHASE
• BEGINS WITHIN 48 HOURS OF RESECTION AND LASTS
UPTO 1-2 YEARS.
• APPROXIMATELY 90%BOWEL ADAPTATION TAKES
PLACE DURING THIS FACE.
• ENTEROCYTE HYPERPLASIA,VILLOUS HYPERPLASIA
AND INCREASED CRYPTS DEPTH OCCCUR.
• INCREASES IN INTESTINAL SURFACE AREA ,
DILATATION AND LENGTHENING OCCUR
• ENTERAL NUTRTION IS ESSENTIAL FOR ADAPTATION
AND SHOULD BE INTIATED AS EARLY AS POSSIBLE
• PARENTRAL NUTRION IS ESSENTIAL THROUGHT OUT
THIS PERIOD

13. MAINTAINCE PHASE
• THE ABSORPTIVE CAPACITY OF INTSTINES IS MAXIMUM IN THIS PHASE
• NUTRTIONAL AND METABOLIC HOMEOSTASIS CAN BE ACHIEVED BY ORAL
FEEDING OR PATIENT COMMITTED TO RECEIVING SUPPLEMENTAL OR COMPLETE
NUTRIONAL SUPPRORT FOR LIFE

14. HOW TO MANAGE?
IN EARLY PHASES OUR CHALLENGES ARE:
• FLUID IMBALANCE
• DIARROHEA
• ELECTROLYTE REPLACEMENT AND MALNUTRTION

15. • FLUID MANGEMENT:
FLUID LOSS WILL BE UPTO 5 LITRES FOR DAY VGOUROUS MONITORING OF
INPUT AND OUTPUT SHOULD BE DONE
CONTROL OF DIARRHOEA:
LOPERAMIDE AND OTHER ANTIMOTILITY DRUGS
OCTEROTIDE- DECREASE SECRETION
NUTRIOTIONAL SUPPORT WITH TPN

16. TPN
• IT’S A DOUBLE EDGED SWORD
• IT IS THE MAJOR SOURCE TO SUPPLY NUTRITION IN EVERY PHASE
• IT HAS IT’S OWN COMPLICATIONS LIKE :VENOUS THROMBOSIS
• CATHETER INDUCED SEPIS
• RENAL FAILURE
• LIVER FAILURE
• OSTEOPOROSIS

17. LATE PHASE
• THE MOST COMMON TYPE OF ENTRAL ARE ELEMENTARY AND POLYMERIC.
• INTIALLY HIGH CARBOHYDRATE AND HIGH PROTIEN SHOULD BE PROVIDED.
• MILK AND MILK PRODUCTS SHOULD BE AVOIDED.
• ISO-OSMOLAR CONETRATIONS WITH SMALL FEEDS SHOULD BE GI VE.
• REDUCTION OF DIETARY FAT

18. • THE HARMONES NEUROTENSISN,BOMBESIN AND GLP-2 HAVE DEMONSTRATED
MARKED MUCOSAL GROWTH.
• TEDUGLUTIDE , A GLP-2 ANOLOGUE HAS BEEN APPROVED FOR FIRST TARGETED
THERUPETIC AGENT TO GAIN APPROVAL.
• SOMATROPIN, ARECOMBINENT HUMAN GROWTH HARMONE ALSO ELICITS
ANABOLIC AND ANTICATABOLIC

19. WHAT DID OUR FATHER SURGEONS?
PACING OF SMALL INTENSTINE TO SLOW DOWN THE MOTILITY TO INCREASES
ABSORPTION.
REVERSAL SMALL BOWEL SEGMENTS.
CONSTRUCTION VLAVES AND SPINCHTER WITHIN THE LUMEN.
BUT NONE OF THEM HAD GIVEN A FRUIT FULL RESULT

20. • BINACHI PROCEDURE :
LONGITUDINALINTESTINAL
LENGHTING AND
TAILORING{LILT}
• SERIAL TRAVERSE
ENTEROPLASTY

21. INTESTINAL TRANSPLANTATION
• STANDARD OF CARE FOR PATIENTS WITH REHABILITAION FAILURE
REHABILITAION FAILURE:POST ABSORPTIVE FALL OF CITRULLINE LEVELS
• LIVER FAILURE
• CATHETER INDUCED SEPSIS
• FREQUENT EPISODES OF SEVERE DEHYDRATION
• THROBOSIS OF MAJOR CENTRAL VEINS

22. • O FK506 IMPROVED THE PROGNOSIS IN INTESTINAL TRANSPLANTATION
PATIENTS.
• THE 1 & 5 YEAR SURVIVAL RATES OF ISOLATED INTESTINAL TRANSPLATION ARE
75% & 45% RESPECTIVELY
• COMBINED INTESTINAL AND LIVER TRANSPLATIONS HAVE COMPARABLE 1 & 5
YEAR SURVIVAL RATES OF 66% & 54%

23. THANK YOU