Short bowel syndrome
Background
- Well-recognized complication of gastric bypass
- Rapid post-prandial gastric emptying, release of gastric hormones, splanchnic vasodilation
- Hyperinsulinemic and hypoglycemic state
Clinical Features
- Nausea/vomiting, bloating, abdominal cramps, diarrhea, diaphoresis
- Early dumping= symptoms 30-60min after a meal
- Late dumping= symptoms 1-3 hours after a meal
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Gastroparesis
- Diabetic ketoacidosis
- Hernia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
- See Abdominal Pain
- Diagnosis of exclusion
Management
- Dietary Modifications
- Avoid highly concentrated foods
- Separate eating and drinking
- Octreotide
- Positive case reports
Disposition
- Home if other diagnoses excluded and able to tolerate oral intake
See Also
References
O'Brien M. Acute Abdominal Pain In: Tintinalli's Emergency Medicine. 7th ed. McGraw-Hill. 2011:Chapter 74
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