Syndrome of a short gut
- Symptoms of the Syndrome of a short gut
- Reasons of the Syndrome of a short gut
- Treatment of the Syndrome of a short gut
The Syndrome of a Short Gut (SSG) is a symptom complex of chronic frustration which develop at patients as a result of surgical removal of the most part of a small bowel or at an exception of a small bowel of processes of digestion and absorption, at formation of interintestinal fistulas or imposing of an anastomosis between high departments of a small bowel and a large intestine. As a result of disturbance of physiological process of digestion the heavy clinical symptoms which are shown digestion disturbance (maldigestiya), absorptions (malabsorption), trofologichesky insufficiency, involvement in pathological process of other bodies and systems develop.
Symptoms of the Syndrome of a short gut:
During a disease it is possible to allocate three periods: the first – the postoperative period, lasting about 2 months, is characterized by plentiful water diarrhea with high losses of sodium, chlorides, potassium, magnesium, bicarbonates, development of heavy metabolic frustration, disturbances of protein, vitamin metabolism, water and electrolytic balance. In the second period, within the first year after operation, there occurs gradual adaptation of a digestive tract: the chair urezhatsya, the broken exchange processes in an organism are partially recovered. However symptoms of a vitamin deficiency, anemia, deficit of body weight remain. The third period is characterized by relative stabilization of a state. In this period complications in the form of formation of bilious and urinary stones, stomach ulcers can be shown. Quite often anemia remains. Any intercurrent diseases, stressful situations, disturbances of a diet can lead to an exacerbation of diarrhea, development of a syndrome of the broken absorption.
Reasons of the Syndrome of a short gut:
Distinguish the following from the factors defining weight of a condition of patients:
a) A partial or limited resection when length of the remote site makes less than 100 cm; b) an extensive resection – more than 100 cm are removed; c) a short gut – the extent of the kept part of a small bowel – less than 100 cm. At a partial enterectomy the course of a disease – subclinical. The extensive enterectomy can lead to development of heavy post-resection disturbances. The short gut does not give the chance to exist without constant medicamentous correction of disturbances of food. Parenteral food, a special enteroalimentation and frequent keursa of hospitalization with long or continuous infusional therapy is required.
a) Proximal, b) distal. Allocate a proximal and distal resection syndrome. The proximal resection syndrome develops during removal of a part of proximal department of a small bowel. In spite of the fact that the majority of feedstuffs is soaked up in a jejunum, diarrhea and metabolic disturbances at this type of operation are not so sharply expressed. In these cases compensatory functions are undertaken by an ileal gut. The distal resection syndrome means a resection of a part of an ileal gut where there is an absorption of B12 vitamin and bile acids. If at the healthy person of 95% of bile acids reabsorbirutsya and only 5% are lost with a stake, then at an ileectomy fecal losses of bile acids considerably increase. The bile acids which are not absorbed in a small bowel in a large intestine inhibit absorption and strengthen secretion of water and electrolytes that is the reason of water diarrhea. The distal resection meets considerably more often than proximal.
Type of imposing of an anastomosis
At a distal extensive resection preservation of the ileocecal valve is important. In this case at patients time of advance and contact of a chyme with a mucous membrane of the rest of a small bowel is considerably extended. Gradually the adaptable mechanisms promoting increase in vsasyvatelny ability of the kept segments of a small bowel develop. During the imposing of an ileotransverzoanastomoz and switching off of the ileocecal valve transit of intestinal contents sharply accelerates, conditions for bacterial contamination of a small bowel are created. Other factor burdening the course of a disease at an extensive ileectomy and imposing of an ileotransverzoanastomoz is preservation of the caecum forming a blind pocket that also leads to bacterial proliferation in a small bowel. Under the influence of colibacilli in proximal departments of a small bowel as a result of strengthening of processes of deconjugation the free bile acids injuring a mucous membrane are formed. At the same time concentration of the conjugated bile acids participating in absorption of lipids decreases. Injury of a mucous membrane is followed by reduction of its euzymatic activity and disturbance of absorption of all feedstuffs. Increase in osmolarity of intestinal contents due to accumulation of not absorbed nutrients results
Treatment of the Syndrome of a short gut:
Treatment and rehabilitation of patients after extensive resections of intestines represent a difficult task. The purpose of treatment of patients with a syndrome of a short gut – to provide the needs of an organism for water, electrolytes and nutrients, at the same time, whenever possible, giving preference oral / to an enteroalimentation before parenteral. Maintaining patients by team of specialists allows to prevent bystry development of dehydration, to reduce risk of the complications connected with KN and artificial nutrition (in particular, abnormal liver functions, septic complications) and to increase quality of life of patients. At the most severe forms (an eyunostoma with a piece of the remained part of a jejunum less than 50 cm) it is vital to provide full parenteral food and a regidratation. At rather long remained piece of a small bowel and preservation of a passage on a large intestine (it is thin – a colic anastomosis) the diet and reception of liquid approaches natural.