Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Shock Short Bowel Syndrome 1343

complications and prognosis

■Renal failure: 2 days -2 weeks; may be permanent

■Hypoxic encephalopathy: may manifest as focal or global event

■Likelihood increased in the presence of CNS vascular disease

■ARDS: Typically 1 week -1 month; 50% mortality mostly secondary

to Multiple Organ Failure Syndrome

■MI: Extent and prognosis depends on preexisting CAD.

■Ischemic colitis: Associated with prolonged hypotension

➣May result in acalculous cholecystitis, pancreatitis, or mesenteric

infarction

➣Mortality from these events as a result of shock is >90%

SHORT BOWEL SYNDROME

GARY M. GRAY, MD

history & physical

History

■Weight loss

■Watery, bulky stools containing undigested food

■Malnutrition

■Conditions that result in insufficient small intestinal mucosa for ade-

quate nutrition:

➣neonatal congenital anomalies (intestinal atresia, gastroschisis)

➣necrotizing enterocolitis

➣volvulus

➣trauma

➣extensive enteropathy (especially Crohn’s disease)

➣mesenteric vascular ischemia

➣collagen vascular disease (especially periarteritis nodosa)

Physical

■Smooth, red tongue

■Cracking at mouth corners

■Pitting edema of lower extremities

■Mental slowness

tests

Basic Blood

■Anemia (iron deficiency; folate/vitamin B 12 deficiency)

■Hypoalbuminemia (albumin often <2.5 gm/dl)