- Functions of the small intestine
- Symptoms of the short bowel syndrome
- Treatment for the short bowel syndrome
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Short bowel syndrome often affects people who have had a fragment of their small intestine removed. This organ is responsible for the absorption of nutrients, so if the patient is deprived of a significant part of it, this function will be impaired. What are the symptoms of short bowel syndrome? How do the sick eat?
Short bowel syndromeis a rare disease. In Poland, 6 people per million suffer from it, and in the USA, for example, 40 people per million. Short bowel syndrome is a consequence of surgical resection of a fragment of the small intestine, although there are also congenital cases. The doctor decides to remove a part of this organ when it is seriously damaged (and therefore does not function) as a result of an injury or some disease, e.g.
- Crohn's disease
- bowel cancer
- intestinal necrosis - this occurs when an embolism or clot occurs in the vessels that nourish the intestines. It closes the lumen of the vessels, the blood stops flowing and the intestine dies. Then such a dead fragment must be removed.
- cramps in the intestine
- internal fistula (connection of the damaged intestinal wall with other organs) or external fistula (connection of the damaged intestinal wall with the skin). The food then travels from the intestines to the center of the abdomen or out.
- neonatal necrotizing enteritis
- intestinal twist
- severe malabsorption. In this case, the short bowel syndrome does not result from the excision of a fragment of the organ, but from its functional disorders. It can occur, for example, in patients after irradiation due to tumors in the abdominal cavity or in patients with cystic fibrosis or refractory celiac disease.
Functions of the small intestine
In an adult, the small intestine is about 6-8 m long. It consists of three parts: duodenum, jejunum and ileum. In the duodenum and the first 120-150 cm of the jejunum, the absorption of proteins, carbohydrates, fats and fluids takes place - thanks to enzymes produced by the pancreas and the intestines themselves. Trypsin and chymotrypsin are responsible for digesting proteins, lipase breaks down fats, and amylase breaks down carbohydrates. As a result of these processes, macronutrients are broken down into component parts and can be absorbed into the blood, and with it transported to each cellof the body.
Water-soluble vitamins are digested and absorbed in the duodenum. Fluids and fat-soluble vitamins are also absorbed in the jejunum: vitamin A, vitamin D, vitamin E, vitamin K, as well as B vitamins, simple sugars, electrolytes and many micro and macro elements: calcium, magnesium, iron and zinc . Hormones such as secretin and cholecystokinin are also produced. In the ileum, the last part of the small intestine, bile s alts, vitamin B12and fat-soluble vitamins are absorbed.Worth knowing
There is a physiological barrier between the small and the large intestine, i.e. the Bauchin ileocecal valve. Behind it, other processes are already taking place, incl. absorption of water from the digestive content. There are also undigested food residues, which are partially decomposed thanks to the bacterial microflora. Microflora also has the ability to synthesize some B vitamins - biotin, riboflavin, niacin, cobalamin and vitamin K. Therefore, after part of the small intestine is removed, these vitamins will be absorbed to some extent at this point (read more about the adaptive mechanism). removal of the ileocecal valve during surgery may displace the bacterial flora, increase bacterial growth, and aggravate the symptoms of short bowel syndrome.
The small intestine, in every section, plays a very important role in digesting and absorbing nutrients from food. Therefore, removing some part of it will result in the fact that the food will not be absorbed to a sufficient degree. This results in disturbances in the functioning of the body and malnutrition of the patient. Inadequately treated short bowel syndrome leads to cachexia and death of the patient
Symptoms of the short bowel syndrome
In the first phase, the patient suffers from abdominal pain and long-lasting diarrhea, which is the cause of water and electrolyte disturbances, dehydration, acidosis, malnutrition and nutritional deficiencies, and cachexia. The patient loses weight and complains of permanent fatigue. Laboratory tests very often indicate:
- deficiencies of fat-soluble vitamins: A, D, E and K and B vitamins
- deficiencies of calcium, iron, folic acid and zinc; this in turn leads to anemia, peeling of the skin, easy bruising, muscle cramps, blood clotting disorders and bone pain
Among the late symptoms of the short bowel syndrome:
- heart rhythm disturbance
- kidney stones
- gallstone disease
- cirrhosis and liver failureliver
- metabolic bone disease - osteopenia and osteoporosis
- stomach ulcer
- iron deficiency anemia
- coagulation disorders
- mental disorders
Treatment for the short bowel syndrome
Symptoms of the short bowel syndrome appear during hospitalization, so they are quickly noticed by doctors and treatment can be started immediately. The patient should be looked after by a parenteral and enteral nutrition clinic and thoroughly educated about his or her he alth condition. Treatment for short bowel syndrome is divided into three periods.
- Postoperative period
As a result of frequent diarrhea, the patient is dehydrated, the electrolyte balance is also disturbed, and the main task of doctors at this stage is to equalize fluids and electrolytes as quickly as possible. The next step is to prevent the development of gastric ulcers - in the short intestine syndrome hydrochloric acid is secreted in excess. Therefore, proton pump inhibitors are used, i.e. drugs that protect the intestinal mucosa and slow down peristalsis. In order to protect the patient from malnutrition, parenteral nutrition is used, i.e. the administration of nutrients directly into the vein. In order for the digestive system not to "become lazy" enteral nutrition should also be carried out - through a gavage or gastrostomy. If the patient is able to take food orally, he should also eat normally, even if it is to be in very small amounts.
- Adaptation period
After a while, parenteral nutrition is gradually reduced in favor of normal nutrition. However, the process is different in each patient and depends on many factors, such as the patient's age (adaptationis best in young children, most difficult in the elderly), the underlying disease, the length of the removed section of the intestine and the specific fragment it was, functional status of the intestinal mucosa, presence or absence of an ileocecal valve, etc. A chance for regaining digestive autonomy after several years of parenteral nutrition is provided by even 50-60 cm of the small intestine in combination with the large intestine, or 100-115 cm in patients without a large intestine.in the case of short bowel syndrome, one can never talk about a cure, but only about adaptation, i.e. the adaptation of the rest of the intestine to the existing situation, and thus taking over the functions that the lost fragments performed. What's going on? Already two days after the operation, very important changes for the body begin to occur, including overgrow intestinal villi and deepenintestinal crypts, which increases the surface of absorption of nutrients and water, supports the motility of the gastrointestinal tract and the secretion of intestinal hormones, and prevents colonization with pathogenic bacterial and fungal flora.
- Period of long-term treatment
It concerns patients with severe forms of the short bowel syndrome. For example, those with an extremely large fragment of this organ removed. They will always need nutritional treatment - enteral, orally assisted or only parenteral. In this case, however, feeding takes place at home. Patients with short bowel syndrome must be under the care of their family doctor, gastroenterologist, and enteral and parenteral nutrition clinics at all times. Each patient is a different case, so there are no general guidelines for what to do during treatment, during recovery or in the rest of life. Certainly, all patients must systematically control the morphology, biochemistry, levels of micro and macro elements, glycaemia, and body weight. This will allow, in the event of any irregularities, to react quickly and prevent complications.