The nutritional management of patients with a short small intestine

McIntyre, Peter Bruce (1984) The nutritional management of patients with a short small intestine. MD thesis, University of Glasgow.

Abstract

The work for this thesis has been inspired by the experience gained from managing patients with inflammatory bowel disease in a specialist centre. An increasing number of patients with Crohn's disease are now surviving repeated intestinal resections which result in a short residual intestine. These patients, and others who have undergone extensive bowel resection secondary to mesenteric vascular disease, neoplasia, or radiation damage may develop a variety of nutritional deficiencies. Those least affected have a tendency to water and sodium depletion requiring oral or parenteral replacement while being able to nourish themselves satisfactorily in the normal way. In the most extreme cases, insufficient bowel remains for satisfactory nutritional function, and parenteral nutrition in the patient's home is necessary to sustain life. This thesis describes the clinical and pathophysiological features of the short bowel syndrome, and reviews the current state of knowledge regarding the use of fluid and electrolyte replacement and dietary manipulation in the management of such patients. The use of supplementary liquid diets and the techniques and problems of home enteral and parenteral nutrition are discussed. Experimental work has been undertaken with a group of patients who suffered from varying disabilities due to a short small intestine. The problems of fluid and electrolyte balance have been studied by comparing the efficiency of different sugar-electrolyte mixtures in improving sodium and water balance. This work was performed in collaboration with Dr C R Newton at St Mark's Hospital. In a series of dietary studies, a whole protein liquid diet has been compared with a chemically defined diet, and with solid food by measuring nitrogen, fat and calorie balances. The effects of varying the fat and fibre content of normal diets upon these parameters, and upon sodium, potassium, calcium and magnesium balance have been investigated. During the investigation and treatment of these patients, techniques for enteral and parenteral nutrition in the home have been developed and refined. These techniques and their complications are described and the results of therapy on patients' medical and social state presented. In the final discussion, the experimental results are drawn together and their relevance to clinical practice is discussed. Guidelines for the oral, enteral and parenteral electrolyte and nutritional support of patients with the short bowel syndrome are suggested. The appendix to the thesis contains case histories of those patients who took part in the studies of electrolyte mixtures, solid diets, and liquid supplements given orally and by nasogastric tube.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Keywords: Medicine, Nutrition, Health care management
• Date of Award: 1984
• Depositing User: Enlighten Team
• Unique ID: glathesis:1984-76528
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 19 Nov 2019 14:13
• Last Modified: 19 Nov 2019 14:13
• URI: https://theses.gla.ac.uk/id/eprint/76528