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Flashcards in Nourani: Short Bowel Syndrome Deck (29)
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1

Malabsorption syndrome that results from extensive intestinal resection

short bowel syndrome

2

In practice, small bowel length of less than (blank) cm is commonly used as an anatomic definition of short bowel syndrome

200

3

Inflammatory bowel disease; Crohns/UC
Mesenteric infarction
Radiation injury

Major causes of short bowel syndrome in adults

4

Congenital anomalies

major cause of short bowel syndrome in infants and children

5

The degree of malabsorption depends on which area of the gut is resected. Which section can be resected with the most mild clinical manifestations? The worst?

ileocolonic anastamosis; jejunocoonic anastamsosis

6

Predominant clinical symptoms of SBS

diarrhea, steatorrhea, weight loss, mineral deficiencies, hypovolemia, low Na+, low K+

7

Some patients can meet caloric and protein needs but still are deficient in (blank). Others have adequate nutrient uptake, but (blank) losses are predominant.

vitamins and minerals; fluid and electrolytes

8

predictor of permanent versus transient intestinal failure

citruline concentrations

9

In humans, (blank) is an amino acid involved in metabolism that is not incorporated in proteins. In the urea cycle, it produces urea from ammonia. Circulating form is mainly produced by enterocytes of the small bowel

citrulline

10

Loss of Absorptive Surface Area
Loss of Site-Specific Transport Processes
Loss of Site-Specific Endocrine Cells and GI Hormones
Loss of the Ilecocecal valve
Intestinal Adaptation to Resection

Pathophysiology of short bowel syndrome

11

The jejunum and ileum are relatively (blank) in terms of mucosal resistance, while the proximal and distal colon is very (blank).

leaky;tight

12

Absorption of some compounds is restricted to certain areas of the small intestine. This can lead to loss of (blank)

site-specific transport processes

13

GI hormones are synthesized in the intestinal mucosa by (blank). These can be lost in bowel resection.

site-specific endocrine cells

14

50% of patients with extensive intestinal resections temporarily develop (blank)

hypergastrinemia = increased gastric acid secretion

15

What do GLP1 and GLP2 do in the gut? What happens to these hormones in patients with SBS?

cause a delay in gastric emptying, so they slow intestinal transit; increased levels

16

Primary function is to
separate ileal and colonic contents
minimize bacterial colonization of the small intestine
regulate emptying of ileal contents into the colon

ileocecal valve

17

Two problems with removing the ileocecal valve

decreased transit time through intestines
increases risk of bacterial overgrowth in small bowel

18

Within 1 to 2 years, what adaptive changes can occur in the ileum to make it more like the jejunum?

ileum attains taller villi and deeper crypts. Can also increase in length and diameter.

19

(blank) is the result of an increase in crypt cell production rate presumably mediated by growth factors released by the presence of food and secretions in the intestinal lumen.

adaptive hyperplasia

20

Patients with SBS with colon in continuity have changes in (blank) that result in an increased capacity to metabolize carbohydrate and in an increased fecal bacterial mass.

colonic flora

21

1. admin of parenteral nutrition
2. prevention of fluid/electrolyte abnormalities

predominant goals after intestinal resection

22

(blank) can be given to suppress gastric hypersecretion

H2 blocker/PPI

23

Continuous (blank) feeding in post-op period can significantly increase net absorption of nutrients. Also, (blank) diets enhance adaptation more readily than elemental diets.

tube feeding; complex

24

Many enteral feeding formulations, especially amino acid solutions, are high in (blank) content.

carbohydrate

25

Principle luminal anions in colon
2-4 carbon compounds that originate from bacteria metabolizing carbohydrates
Rapidly cleared from the colon to enhance Na+ absorption

short chain fatty acids

26

Malabsorbed carbohydrates and proteins are degraded by bacterial enzymes in the colon to (blank) and lactate, which are readily absorbed by colonic epithelium

short chain fatty acids

27

(blank) enteral feeding permits constant saturation of carrier transport proteins

continuous

28

With chronic enteral nutrition, avoid high (blank) feedings, because simple carbs may cause osmotic diarrhea

carb

29

(blank) will often improve diarrhea associated with bile salt malabsorption.

cholestyramine