Algorithm for Management of the Patient with Short Bowel Syndrome - Flowchart
Algorithm for Management of the Patient with Short Bowel Syndrome - Flowchart Short Bowel Syndrome Short Bowel Syndrome
«Flowchart»

Start

Start

Start

Jejunoileal anastomosis, no colon present

Jejunoileal anastomosis, no colon present

Jejunoileal anastomosis, no colon present

End jejunostomy

End jejunostomy

End jejunostomy

Jejunoileal anastomosis

Jejunoileal anastomosis

Jejunoileal anastomosis

Partial TPN support with weaning

Partial TPN support with weaning

Partial TPN support with weaning

TPN likely

TPN likely

TPN likely

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPl for the 1st 6 mo
Antidiarrheal therapy
Oral calcium supplements
TPN at home
Teaching of appropriate catheter care

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPl for the 1st 6 mo
Antidiarrheal therapy
Oral calcium supplements
TPN at home
Teaching of appropriate catheter care

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPl for the 1st 6 mo
Antidiarrheal therapy
Oral calcium supplements
TPN at home
Teaching of appropriate catheter care




2



Continue above measures
Monitor vitamin and mineral status
Yearly bone densitometry

Continue above measures
Monitor vitamin and mineral status
Yearly bone densitometry

Continue above measures
Monitor vitamin and mineral status
Yearly bone densitometry



Monitor calcium and vitamin D status
Consider IV bisphosphonate therapy

Monitor calcium and vitamin D status
Consider IV bisphosphonate therapy

Monitor calcium and vitamin D status
Consider IV bisphosphonate therapy


Monitor for signs of catheter infection

Monitor for signs of catheter infection

Monitor for signs of catheter infection

Encourage oral food intake to avoid gallbladder stasis
Cholecystectomy for cholecystitis

Encourage oral food intake to avoid gallbladder stasis
Cholecystectomy for cholecystitis

Encourage oral food intake to avoid gallbladder stasis
Cholecystectomy for cholecystitis


Intestinal/liver transplantation

Intestinal/liver transplantation

Intestinal/liver transplantation

End

End

End

Live donor intestinal transplantation

Live donor intestinal transplantation

Live donor intestinal transplantation

Cadaveric intestinal transplantation

Cadaveric intestinal transplantation

Cadaveric intestinal transplantation

Live donor available?

Live donor available?

Live donor available?

Yes

Yes

Yes

No

No

No

Monitor for and manage complications

Monitor for and manage complications

Monitor for and manage complications

Hepatic

Hepatic

Hepatic

Infectious

Infectious

Infectious

Biliary

Biliary

Biliary

Renal

Renal

Renal

Bone

Bone

Bone

Catheter occlusion

Catheter occlusion

Catheter occlusion

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPI for the 1st 6 mo
Antidiarrheal therapy
High-complex-carbohydrate diet
Low oxalate diet
Oral calcium supplements
MCT
Attempt TPN weaning
Teaching of appropriate catheter care
TPN at home

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPI for the 1st 6 mo
Antidiarrheal therapy
High-complex-carbohydrate diet
Low oxalate diet
Oral calcium supplements
MCT
Attempt TPN weaning
Teaching of appropriate catheter care
TPN at home

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPI for the 1st 6 mo
Antidiarrheal therapy
High-complex-carbohydrate diet
Low oxalate diet
Oral calcium supplements
MCT
Attempt TPN weaning
Teaching of appropriate catheter care
TPN at home




2







TPN generally not required

TPN generally not required

TPN generally not required

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPI for the 1st 6 mo
Antidiarrheal therapy
High-complex-carbohydrate diet
Low oxalate diet
Oral calcium supplements
MCT

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPI for the 1st 6 mo
Antidiarrheal therapy
High-complex-carbohydrate diet
Low oxalate diet
Oral calcium supplements
MCT

Oral rehydration solutions
Electrolyte replacement/monitoring
Fluid management
H2RA or PPI for the 1st 6 mo
Antidiarrheal therapy
High-complex-carbohydrate diet
Low oxalate diet
Oral calcium supplements
MCT




2




H2RA, histamine 2 receptor antagonist; IV, intravenous; MCT, medium-chain triglycerides; PPI, proton pump inhibitor; TPN, total parenteral nutrition.

H2RA, histamine 2 receptor antagonist; IV, intravenous; MCT, medium-chain triglycerides; PPI, proton pump inhibitor; TPN, total parenteral nutrition.

H2RA, histamine 2 receptor antagonist; IV, intravenous; MCT, medium-chain triglycerides; PPI, proton pump inhibitor; TPN, total parenteral nutrition.

H2RA 2 IV MCT PPI TPN

<100 cm residual small intestine

<100 cm residual small intestine

<100 cm

100 cm residual small intestine

100 cm residual small intestine

>=100 cm

Avoid dextrose overfeeding
Use <2.5 g/kg/d lipid, and if possible <1.5 g/kg/d
Diagnostic testing

Avoid dextrose overfeeding
Use <2.5 g/kg/d lipid, and if possible <1.5 g/kg/d
Diagnostic testing

Avoid dextrose overfeeding
Use <2.5 g/kg/d lipid, and if possible <1.5 g/kg/d
Diagnostic testing



Improvement

Improvement

Improvement

No improvement

No improvement

No improvement

Re-anastomosis of colon, if possible

Re-anastomosis of colon, if possible

Re-anastomosis of colon, if possible

100 cm small intestine + colon

100 cm small intestine + colon

>=100 cm small intestine + colon

<100 cm small intestine + colon or <150 cm small intestine + partial colon

<100 cm small intestine + colon or <150 cm small intestine + partial colon

<100 cm small intestine + colon

<100 cm small intestine + colon or <150 cm small intestine + partial colon

<100 cm small intestine + colon or <150 cm small intestine + partial colon

<100 cm small intestine + colon

Partial TPN support with weaning

Partial TPN support with weaning

Partial TPN support with weaning