Short Bowel Syndrome

Disease class: Malabsorption syndromes

Also known as 

• SBS
• Short gut

 

Pathophysiology

The small intestine varies in length from 2.75m to 10.49m. The average length is 6.1m. Short bowel syndrome usually develops when there is less than 2m of working bowel.
In SBS, the deficiency in intestinal function is so extensive that nutrients, water, and electrolytes are not sufficiently absorbed.  It is the most common cause of intestinal failure.

 

Causes

This is usually the result of enterectomy (surgical bowel resection).
This can be necessary treatment for:

• Crohn's disease
• Necrotising enterocolitis

Rarely this is a congenital disease.

 

Signs and symptoms

• Abdominal pain
• Diarrhoea 
• Steatorrhoea
• Fluid depletion
• Weight loss
• Malnutrition
• Fatigue

 

Complications 

• Vitamin B9 deficiency
• Vitamin B12 deficiency
• Iron deficiency anaemia
• Vitamin A deficiency
• Vitamin D deficiency
• Vitamin E deficiency
• Vitamin K deficiency 
• Calcium deficiency
• Magnesium deficiency
• Zinc deficiency

Coeliac disease

Disease class: Malabsorption syndromes

Also known as 

• Celiac disease

 

Pathophysiology

• Gluten contains a protein called gliadin. 
• When a patient with Coeliac disease ingests gliadin, there is a hypersensitivity reaction.
• This is a Type IV hypersensitivity reaction.
• The bowel is damaged, causing atrophy of villi (villous atrophy).

 

Symptoms

• Diarrhoea
• Steatorrhea
• Weight loss or failure to thrive
• Fatigue 
• Abdominal pain 
• Cramping
• Bloating

 

Signs

• Abdominal distension

 

Complications

• Dermatitis herpetiformis 
• Iron deficiency anaemia 
• Folic acid deficiency
• Vitamin B12 deficiency
• Vitamin K deficiency 
• Selenium deficiency

 

Investigations

• Full blood count
• Anti-Tissue Transglutaminase
• Anti-endomysial (EMA) antibodies 
• Upper GI endoscopy
• Duodenal biopsy 
• Dual-energy X-ray absorptiometry

 

Management

• Dietary: Gluten-free diet