Gastroenterology

Question 1

Definition of Short bowel syndrome

Answer 1

Need for PN >60 days

Or <25% expected bowel length

Question 2

Intestinal adaptation depends on

Answer 2

Residual bowel length
Ileal> jejunum
Quality if bowel
Colom

Question 3

Trophic feeds cause

Answer 3

GI hormone secretion:

GH growth of intestinal layers

IGF1 enterocyte proliferation +/- bowel lengthening

GLP2 (produced in colon) stimulate nutrients
- clinical trials of analogues are underway

EGF enterocyte proliferation

Question 4

Which formula to use for trophic feeds

Answer 4

Breastmilk

Extensively hydrolyzed is more easily digested but less likely to lead to intestinal adaptation

Polymeric formula may be better at supporting intestinal adaptation

Question 5

Complications of PN

Answer 5

Oral aversion
Cholestasis
Electrolyte abnormalities
Micronutrient deficiency 
Cvad related

Question 6

Complications of SBS

Answer 6

Malnutrition
- essential fatty acid and bile acid
- micronutrients
Fluid and electrolyte
Metabolic bone disease 

Dumping syndrome
Gastric hypersecretion
- peptic ulcer
- bile acid precipitation 
- inactivation of pancreatic enzymes
SBO

Urinary oxalate stones

Question 7

Small bowel bacterial overgrowth

Answer 7

Bloating diarrhea
Cant form micelles –> Steatorrhea
B12 deficiency
Lactobacillus –> Synthesis of d lactate and ammonia

Question 8

Treatment of small bowel overgrowth

Answer 8

Correct metabolic acidosis
Antibiotics 
Restrict carbohydrate intake
Probiotics withiut lactobillus
Bicarbonate (lactobacillus love acid)

Question 9

PN related liver disease

Answer 9

High glucose –> causes hyperinsulinism –> liver steatosis

Lipid emulsions are toxic, but SMOF is less toxic

Question 10

Treatment of SBS

Answer 10

Cholestyramine
Loperamide
Surgical