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What is Short Bowel Syndrome?
Short bowel syndrome (SBS) occurs when a significant portion of the small intestine is surgically removed or not developed properly. The small intestine, which is usually about 20 feet long in adults, is responsible for absorbing nutrients, electrolytes and fluids from food. When too much of the small intestine is gone, the body cannot absorb enough vitamins, minerals, carbohydrates, proteins and fat to function properly.
Causes and Risk Factors
There are several potential causes and risk factors for developing SBS:
– Intestinal disease or damage: Conditions like Crohn’s disease, intestinal infection or injury that requires removing part of the small intestine through surgery. Premature births that require resection of diseased areas of the bowel are also common causes.
– Congenital abnormalities: Babies born with certain birth defects affecting the development of the digestive system, like gastroschisis or volvulus, are at risk.
– Vascular disorders: Problems with blood supply to the intestines from conditions like mesenteric ischemia can damage the bowel tissue.
– Tumors: Cancers of the small intestine or nearby abdominal organs sometimes require removing large sections of the bowel during surgery.
Symptoms
Some common symptoms experienced by patients with SBS include:
– Diarrhea: Frequent, loose stools occur as the intestine has trouble absorbing nutrients and fluid. Diarrhea is often problematic as it leads to further malnutrition.
– Dehydration: Frequent diarrhea leads to excess fluid loss and dehydration if fluids are not replaced adequately. This can be life-threatening.
– Malnutrition and weight loss: Not enough calories and nutrients are absorbed to meet the body’s needs, resulting in wasting and undernourishment over time.
– Fatigue and weakness: Malabsorption of nutrients causes a lack of energy and diminished strength.
– Bone disease: Absorption issues with calcium, vitamin D and other minerals long-term can lead to conditions like osteopenia or osteoporosis.
– Electrolyte imbalances: Especially when diarrhea is severe, important minerals like sodium, potassium and magnesium may become depleted.
Diagnosis and Treatment
Doctors will consider a patient’s medical history and conduct a physical exam. Diagnostic tests may include:
– X-rays of the abdomen to evaluate bowel size and integrity
– CT scans or MRI imaging for more detail
– Tests of digestive function like D-xylose absorption tests
– Analysis of stool contents
The primary goals in managing SBS are reducing diarrhea, maximizing nutrient absorption, and preventing malnutrition complications. Treatment options may include:
– Medications to reduce bowel motility and allow more time for nutrient uptake
– Parenteral nutrition delivered directly into the bloodstream via central IV line
– Revision surgeries like small bowel transplant or lengthening procedures
– Probiotics to restore healthy gut bacteria
– Vitamin and mineral supplements
Living with Short Bowel Syndrome
While SBS creates lifelong challenges, many people are able to adapt and lead fulfilling lives with the proper treatment regimen. Key aspects of long-term care include:
– Strictly following a nutrient-dense, low-residue diet as advised by a registered dietitian. Fiber intake must be gradual.
– Staying well-hydrated through oral rehydration solutions and monitoring hydration status.
– Preventing and treating infections through good hygiene, vaccination and prompt antibiotic treatment if needed.
– Carefully monitoring for signs of malnutrition, dehydration or electrolyte issues and contacting the doctor with any concerns.
– Getting regular blood work done to check vitamin, mineral and nutritional status.
– Using parenteral nutrition or IV supplementation as directed by the medical team. Weaning off TPN support occurs gradually if possible.
– Coping with emotional aspects like body image issues, dietary restrictions or fears about malnutrition and health complications. Support groups can help.
With diligent lifestyle management and medical follow-up, people with SBS can expect to live full lives. Current research also aims to develop new therapies that may someday restore more normal intestinal function.
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