Chapter 161. Small Bowel Disorders

Malabsorption and Celiac Disease

1. Does this patient have malabsorption?

2. Is the malabsorption due to celiac disease?

3. What other diseases need to be considered?

4. What are the consequences of malabsorption?

5. How is malabsorption managed?

Small Bowel Obstruction

1. What are common causes of small bowel obstruction?

2. How do patients present with small bowel obstruction?

3. When do patients with small bowel obstruction need to go to surgery and when can they be managed medically?

4. Can small bowel obstruction be prevented?

Small Bowel Ileus

1. What conditions predispose to small bowel ileus?

2. Can small bowel ileus be prevented?

3. How is small bowel ileus treated?

4. When can a patient resume oral intake?

Acute Mesenteric Ischemia

1. Does this patient have acute mesenteric ischemia?

2. What conditions predispose to mesenteric ischemia?

3. How does mesenteric ischemia differ from colonic ischemia?

4. Is emergent surgery necessary?

Introduction and Epidiemiology

Numerous causes lead to malabsorption and maldigestion, ranging from the common to the obscure. Lactose intolerance, for example, is present in 7% to 20% of Caucasian adults, 50% of Hispanics, 65% to 75% of African Americans, and 90% in some East Asian populations. Celiac disease is most commonly seen in whites of northern European ancestry. In a large screening study from the United States, the prevalence of celiac disease in average risk individuals was 1:133. The prevalence was highest in first-degree relatives of a patient with celiac disease (1:22). Other disorders, such as primary intestinal lymphangiectasias, occur so rarely that it is difficult to estimate their true prevalence.

Presentation

Patients with malabsorption often report weight loss, diarrhea, anorexia, flatulence, borborygmi, and/or greasy, foul smelling, voluminous pale stools. Patients may also have symptoms related to specific micronutrient deficiencies (Table 161-1). Some patients, however, are asymptomatic.