Case 18.5
How does short bowel anatomy predict intestinal adaptation and also complications from intestinal failure? Which of the following is FALSE?
A patient with a jejunostomy has more rapid gastric emptying than one with the ileum and/or colon in continuity.
The colon can adapt to absorb up to 6 liters of fluid, and 1000 kcal per day from absorption of short chain fatty acids produced by microbiota in the colon. This results in improved adaptation if the colon is in continuity with the small bowel.
A person with a jejunostomy has a better chance of achieving parenteral nutrition independence than one with an ileostomy as the jejunum is more efficient than the ileum at undergoing intestinal adaptation.
A patient with their colon in continuity is at risk of developing hyperoxaluria, which can lead to renal disease.
A patient with their colon in continuity is at risk of developing D-lactic acidosis.
You start the patient on diphenoxylate/atropine up to 4 times daily, but she continues to have frequent stools, and is still dependent on total parenteral nutrition. You discuss the possibility of starting teduglutide, a GLP-2 agonist FDA (Food and Drug Administration) approved for the management of intestinal failure. This medication works by acting as a trophic factor for intestinal mucosa, increasing villus height and crypt depth, and also by slowing intestinal motility. She decides she would like to try other treatments first due to concern for side effects from teduglutide.
What other medications can be used as an adjunct to treat diarrhea in this patient prior to initiating teduglutide? Choose all that apply.
Loperamide
Tiral of Pancreatic Enzymes
Trial of antibiotics to treat underlying SIBO
Tincture of opium
Subcutatneous Octreotide
Clonidine Patch