PRACTICAL MANAGEMENT OF THE SHORT-BOWEL

A shortened small intestine may end at a stoma or be anastomosed to th e colon, Patients with a jejunostomy, but not those with a colon, lose large amounts of sodium. The intake and absorption of sodium can be i ncreased by sipping a sodium-glucose solution; stomal loss can be redu ced by restricting water or low-sodium drinks, If a stoma is situated less than 100 cm along the jejunum, a constant negative sodium balance may necessitate parenteral saline supplements, Gastric antisecretory drugs or a somatostatin analogue reduce jejunostomy losses in such pat ients but do not restore a positive sodium balance, Loperamide or code ine phosphate benefit some patients, Magnesium deficiency can usually be corrected by oral magnesium oxide supplements. An elemental or hydr olysed diet is not beneficial, Patients with a jejunostomy can maintai n a normal diet without fat reduction, When the colon is present, unab sorbed carbohydrate is fermented to absorbable short chain fatty acids . Unabsorbed long chain fatty acids and bile salts cause watery diarrh oea and increased colonic oxalate absorption with hyperoxaluria, Such patients benefit from a high carbohydrate, low-fat and low-oxalate die t. Parenteral nutrition is needed only by the few patients unable to m aintain health or avoid socially disabling diarrhoea despite these mea sures.