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Short Bowel Syndrome - Surgical Lecture
PptxGenJS Presentation
Prof. Zahid Mahmood
Prof. Zahid Mahmood
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2026-04-08T00:40:33Z
2026-04-08T00:40:33Z
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Short Bowel SyndromeBailey & Love — Latest EditionProf. Zahid MahmoodDepartment of SurgeryFinal Year MBBS | UHS / CPSP Aligned CurriculumBailey & Love Style · Exam-Oriented · Viva Ready · Case-Based LearningPK
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02Learning Outcomes▶ Define SBS; state diagnostic length criteria▶ Classify types; understand each type physiology▶ Enumerate causes and precipitating factors▶ Plan management — acute to chronic phasesProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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03Definition (Bailey & Love)▶ SBS: <200 cm small bowel post-resection▶ Functional SBS: bowel present; absorption fails▶ Incidence: ~3/million; rare; life-threatening▶ Intestinal failure: unable to maintain nutritionProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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04Classification — Anatomical Types▶ Type I: End jejunostomy; no colon; high output▶ Type II: Jejuno-colic; partial colon; adapts▶ Type III: Jejuno-ileo-colic; ICV preserved▶ ICV retention = key to spontaneous adaptationProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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05Etiology / Causes▶ Crohn's disease: commonest cause in adults (UK)▶ Mesenteric ischaemia: SMA embolus/thrombosis▶ Radiation enteritis: fibrosis → necrosis▶ Neonatal: gastroschisis, NEC, intestinal atresiaProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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06Pathophysiology — Three Phases (B&L)▶ Phase 1 (0–4 wks): hypersecretion; high output▶ Phase 2 (4 wks–2 yrs): villous hyperplasia▶ Phase 3 Maintenance: stable; TPN or enteral▶ Colon ferments CHO; salvages extra caloriesProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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07Pathophysiology — Why Absorption Fails▶ ↓ mucosa → fat, protein, B12 malabsorb▶ Loss of ICV → rapid transit + bacterial growth▶ Bile salt depletion → fat malabsorption▶ Oxalate hyperabsorption → renal stonesProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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08Clinical Features — Signs & Symptoms▶ Diarrhoea / high stoma output (>1500 ml/day)▶ Weight loss; muscle wasting; gross malnutrition▶ Dehydration: ↓ Na, ↓ K, ↓ Mg; metabolic acidosis▶ Renal stones; night blindness; bone pain (vit D)Prof. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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09Investigations — Labs & Imaging▶ FBC, U&E, Mg, phosphate, Zn, vit B12, folate, D▶ 72-hr faecal fat: quantifies malabsorption▶ CT/MRI enterography: bowel length + anatomy▶ Citrulline >20 µmol/L = adequate enterocyte massProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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10Management — Acute Phase (B&L)▶ IV Hartmann's; replace stoma fluid losses▶ TPN: start immediately; maintain nutrition▶ Antisecretory: PPI + Octreotide → ↓ output▶ Loperamide: ↑ transit time; codeine adjunctProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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11Management — Intestinal Rehabilitation▶ Enteral feeding: start early; drives adaptation▶ Glutamine: enterocyte fuel; promotes adapt.▶ Teduglutide GLP-2: NICE-approved; ↑ absorb▶ Target: wean TPN; >100 cm = best chanceProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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12Surgical Management▶ STEP: serial transverse enteroplasty; ↑ length▶ Bianchi: bowel-lengthening; longitudinal split▶ Reversed segment: slows transit; controversial▶ Intestinal transplant: last resort; 50% 5-yrProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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13Complications — Early & Late▶ Early: sepsis; catheter bloodstream infection▶ IFALD: intestinal failure–liver disease▶ Renal: oxalate stones; nephrocalcinosis▶ Late: D-lactic acidosis; Mg↓; bone diseaseProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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14TPN & IFALD — High-Yield Points (B&L)▶ IFALD: TPN cholestasis → cirrhosis; fatal▶ Prevent: cycle TPN; use enteral feed always▶ SMOF lipid: fish oil-based; reduces IFALD risk▶ IFALD: reverses only with transplant or TPN weanProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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15Mnemonics & High-Yield Exam Points▶ <200 cm = SBS; <100 cm = likely TPN-dependent▶ 3 phases: Acute → Adapt → Maintain (B&L)▶ STEP = serial transverse enteroplasty; ↑ length▶ Teduglutide = GLP-2 agonist; NICE for SBSProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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Clinical Scenario — Case-Based LearningCASE: 38-yr female with Crohn's disease undergoes emergency resection for SMA thrombosis. Post-op bowel length = 80 cm; no ileocaecal valve; end-jejunostomy fashioned. Day 3: stoma output 2,400 ml. Na 128, K 2.9, albumin 22 g/L. She is on TPN.Q1: Diagnosis and classification?✔ Short Bowel Syndrome — Type I (end jejunostomy, no colon); likely TPN-dependentQ2: Immediate and long-term management?✔ IV fluids + electrolytes; TPN; Loperamide; Octreotide; consider Teduglutide laterProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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MCQs — SBA Style (CPSP / UHS Pattern)1Q1. SBS is defined as remaining small bowel less than?A) 50 cm B) 100 cm C) 200 cm ✔ D) 300 cm2Q2. Commonest cause of SBS in adults in the UK?A) Volvulus B) Radiation C) Crohn's disease ✔ D) Ischaemia3Q3. GLP-2 agonist approved by NICE for SBS?A) Octreotide B) Teduglutide ✔ C) Glutamine D) Loperamide4Q4. Surgical lengthening procedure for SBS is called?A) Bianchi B) STEP ✔ C) Hartmann's D) DuhamelProf. Zahid Mahmood | Short Bowel Syndrome | Final Year MBBS | UHS / CPSPPK
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High-Yield Summary 1SBS = <200 cm bowel; <100 cm = likely TPN-dependent 23 phases: Acute → Adaptation → Maintenance (B&L) 3Teduglutide (GLP-2 agonist) — NICE-approved; weans TPN 4IFALD: TPN-related liver failure; prevented by enteral feedsProf. Zahid Mahmood | Short Bowel Syndrome | End of LecturePK
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