Page 1044 - Small Animal Clinical Nutrition 5th Edition

Chapter
59

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Short Bowel Syndrome

Deborah J. Davenport
Chris L. Ludlow
Rebecca L. Remillard

“Who needs such a long intestine, anyway?”
Moshe Dayan

CLINICAL IMPORTANCE PATIENT ASSESSMENT

Short bowel syndrome is a malabsorptive state that may devel- History and Physical Examination
op after massive resection of the small intestine (Vanderhoof Dogs with short bowel syndrome typically develop diarrhea
and Langnas, 1997). Short bowel syndrome is an important one or more days after a large portion of the small bowel is
clinical entity in people but is uncommon in dogs and cats.This resected (Gorman et al, 2006; Yanoff et al, 1992). The diarrhea
difference probably reflects the relative frequency with which may be intermittent or persistent. Stools range from soft, cow-
predisposing conditions occur. In people, the most common pie consistency to explosive, watery diarrhea. In longstanding
reasons for extensive bowel resection are inflammatory and cases, the patient may have weight loss, polyphagia and evi-
neoplastic conditions in which the residual bowel is often com- dence of malnutrition.
promised. In dogs and cats, a number of intestinal conditions Occasionally, patients present weeks to months after surgery
may warrant the removal of large segments of the bowel, with small bowel diarrhea, flatulence and borborygmus. A
including linear foreign bodies, intussusception, volvulus, delayed onset of clinical signs is associated with small intestin-
infarction, neoplasia, entrapment, gastrointestinal (GI) surgical al bacterial overgrowth, which can develop as a sequela to resec-
site dehiscence and fungal infections. In many of these condi- tion of the ileocolic valve. Physical examination findings are us-
tions, the remaining intestine is healthy.The syndrome is char- ually unremarkable. Body condition assessment may demon-
acterized by malabsorption due to lack of gut surface area strate poor condition (body condition score 1/5 or 2/5). Most
resulting in diarrhea, malnutrition and weight loss. Short bowel patients are bright, alert and active with an increased appetite.
syndrome may occur whenever large segments of the small
intestine (≥50%) are excised surgically (Gorman et al, 2006; Laboratory and Other Clinical Information
Yanoff and Willard, 1989; Yanoff et al, 1992; Pawlusiow and Hematologic and biochemical findings are variable, often
McCarthy, 1994; Williams and Burrows, 1981; Joy and reflecting the underlying condition that led to the bowel resec-
Patterson, 1978; Feldman et al, 1976; Uchiyama et al, 1996). tion. Hypoproteinemia and hypoalbuminemia may be present
However, one retrospective study was unable to correlate the in long-term cases. Mild, normocytic, normochromic non-
percentage of resected bowel with the development of short regenerative anemia may be recognized as a consequence of
bowel syndrome (Gorman et al, 2006). chronic disease. Patients in which the ileum has been resected