Short Bowel Syndrome Causes And Symptoms

Short Bowel Syndrome

By resection (removal) of a part of the small intestine, fluid and electrolyte imbalances can occur and significant nutrtional deficits, that must be known in order to be treated. The small intestine is represented by the duodenum, jejunum and ileum, with an overall length between 3 and 8 meters. The ileum continues with the cecum(the more dilated part of the colon in which the appendix opens), the transition being made from the ileocecal valve, that prevents colon content reflux back into the small intestine. In various diseases surgical resection of a large or small part of the intestine is required. If the remaining part of intestine is under 2 meters, then the short bowel syndrome occurs characterized by poor absorption of certain nutrients.

Short Bowel Syndrome Causes

The Causes that can lead to short bowel syndrome are:

1. Surgical Resections used for:

• Acute surgical abdomen strangulated hernia, volvulus, intussusception, mesenteric or intestine infarction, abdominal trauma with damage to the small intestine
• Crohn’s disease
• Colorectal cancer or other cancers with invasion at this level ,

2. Bypassing a large portion of the intestine through bypass surgery for morbid obesity (see obesity)

3. Intestine malformation (common cause in children)

The degree of nutritional damage depends on:

• The length of the bowel resection (greater the resection the surface of absorption of nutrients is smaller)
• The segment removed (the duodenum and jejunum of the initial part is absorbed calcium, magnesium, iron, folic acid and secrete water and electrolytes: sodium, potassium, chloride and in the terminal jejunum absorbs B12, bile acids, water and electrolytes)
• The presence or absence of valve ileo-CECA -Ability to adapt to new conditions remaining intestine

Short Bowel Syndrome Symptoms

The most common symptoms of short bowel syndrome are:

• Watery diarrhea with frequent stools and high-normal amounts immediately after surgery and large resections or steatorrhea diarrhea, with pasty and oily stools (see chronic pancreatitis) occurring due to poor absorption (malabsorption) of fats due to the lack of absorption of bile acids (in order to be absorbed from the intestine into the bloodstream, fats require bile acids and salts)
• Gallstones caused by the same bile malabsorption mechanism
• Kidney stones by increasing absorption of excess oxalates
• Peptic esophagitis, gastric or duodenal ulcers  due to acid hypersecretion in extensive resections
• Lack of nutrients: protein, leading to edema, carbohydrates, lipids
• Vitamin deficiency: A, eye damage, D, bone damage, E, K, leading to coagulation disorders, B12, with megaloblastic anemia, folic acid, with the development of anemia similar to that of B12 deficiency;
• Mineral deficiency: iron deficiency anemia, sodium, potassium, calcium, magnesium deficiency with their consequences
• Trace element deficiency : zinc, selenium.

Tests indicated for short bowel syndrome are:

1. Determining the length and any remaining bowel anastomoses performed during surgery
2. Tests to emphasize malabsorption of carbohydrates (D-xylose test), B12 (Schilling test) or fat (steatorrhea)
3. Blood tests that will highlight the above mentioned deficits