1. LIZ SERCHEN, BROOKE MALNORY, JILL MCCABE, JOSH REITER SHORT BOWEL SYNDROME

2. DEFINITION Condition in which nutrients are not properly absorbed due to severe intestinal disease or surgical removal of a large portion of the small intestine Occurs in 15% of adult patients who undergo intestinal resection

3. CAUSES IN CHILDREN & ADULTS Intussusception – when part of the intestine folds into another part Crohn’s disease – inflammatory bowel disease Bowel injury from trauma Cancer and damage to the bowel caused by cancer treatment

4. SIGNS & SYMPTOMS Diarrhea is main symptom Can lead to dehydration, malnutrition, and weight loss Other symptoms Cramping Bloating Heartburn Weakness and fatigue Edema Nutrient Deficiencies

5. INTESTINAL ADAPTION After removal of small intestine, the remaining portion goes through adaption that increases its ability to absorb nutrients The inner lining grows, increasing its absorptive surface area Can take up to 2 years to occur

6. MEDICATIONS H2 blockers, antidiarrheals, cholestyramine Control bowel movements Octreotide : slows intestinal transit and increases sodium and water reabsorption Risk of cholelithiasis (gall stone formation) Glucose polymer-based oral rehydration salts (ORS): improve hydration and reduce total parenteral nutrition requirements

7. MEDICATIONS Growth Hormones (somatropin) Norditropin FlexPro, Norditropin Nordiflex, Zorbtive, Accretropin Interferes with steroids and diabetes medication Injected into a muscle or under the skin Use a different place on body for every injection Avoid fruit juices, soda, and alcohol Needs to be taken with diet plan

8. MEDICATIONS Nutraceutical Products (glutamine) GlutaSolve, SYMPT-X G.I., NutreStore Medical food product that is used to supplement dietary sources of glutamine Used in combination wit human growth hormone Glutamine tablets taken on an empty stomach, at least 1-2 hours after a meal No specific drug/food interactions, consult doctor

9. LAB VALUES Complete Blood Cell Count Determine if anemic Albumin Overall nutritional status and hepatic protein synthesis Prealbumin Acute nutritional status, but albumin is better Liver Enzymes Enzymes increasing could lead to liver failure, damage, or cirrhosis BUN and Creatinine Renal function and protein amounts

10. LAB VALUES Nitrogen balance Immune function, wound healing, growth Vitamin levels Trace elements: degradation in enzyme function Deficiencies: treating if necessary Part of intestine affects which vitamins are deficient

11. TESTS Hepatic Histology Transplants based on this Hepatic cirrhosis requires a liver and a small bowel transplant Lab Tests Electrolyte and vitamin levels Stool tests- absorption of dietary fat CT enterography Abnormalities in small intestine Endoscopy Biopsys possible Colonscopy

12. TESTS Bone Densitometry Risk for metabolic bone disease, prone to fractures, calcium and vitamin D malabsorption Chest Radiograph Patients with catheters Abdominal Radiograph Bowel status Abdominal Computed Tomography (CT) Scan Bowel obstructions, liver cirrhosis or dysfunction Abdominal Ultrasonogram Gallstones, gall bladder thickness and common bile duct Fatty change of liver

13. REFERENCES Cagir, B. (2012). Short-bowel syndrome workup. Retrieved from http://emedicine.medscape.com/article/193391-workup Drug Information Online. (2012). Interactions Checker. Available at: http://www.drugs.com/. Accessed February 29, 2012. Mayo Clinic Staff (2012). Short bowel syndrome. Retrieved from http://www.mayoclinic.org/short- bowel-syndrome/ Seetharam P, Rodrigues G. Short Bowel Syndrome: A Review of Management Options. Saudi Journal Of Gastroenterology [serial online]. July 2011;17(4):229-235. Available from: Academic Search Complete, Ipswich, MA. Accessed March 4, 2012. U.S. Department of Health and Human Services. (2009). National Digestive Diseases Information Clearinghouse. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/shortbowel/. Accessed February 29, 2012.