CNSC Exam 2026 > SBS > Flashcards

SBS Flashcards

(54 cards)

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1
Q

normal adult small bowel length

A

400-800 cm (avg 630 cm men and 590 cm women)

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2
Q

how much small bowel remaining to reduce PN dependency with jejunoileocolonic anastomosis?

A

30 cm

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3
Q

how much small bowel remaining to reduce PN dependency with jejunocolonic anastomosis?

A

60 cm

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4
Q

how much small bowel remaining to reduce PN dependency with end jejunostomy?

A

100 cm
*most likely to require permanent PN compared to jejunocolonic anastomosis and jejunoileocolonic anastomosis

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5
Q

terminal ileum is primary site for….

A

B12 absorption and enterohepatic recirculation of bile

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6
Q

how is bile loss impacted when >100 cm of terminal ileum is resected?

A

the amount of unrecycled bile loss > maximum rate of hepatic bile synthesis
-causes bile insufficiency, fat malabsorption, steatorrhea

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7
Q

when > ____ cm of terminal ileum is resected, sites of B12 absorption are decreased thus increasing deficiency risk

A

60 cm

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8
Q

ileal brake

A

slows GI transit in response to enteric hormones (GLP-1, GLP-2, peptide YY)

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9
Q

how is ileal brake impacted in a partial or complete ileal resection?

A

mechanism is compromised and contributes to acceleration of GI transit

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10
Q

role of colon in hydration

A

absorbs water from stool and helps decrease dehydration risk

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11
Q

where is site for bacterial fermentation of fiber and malabsorbed CHOs into SCFAs?

A

colon

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12
Q

which part of small intestine is responsible for most of nutrient absorption?

A

jejunum
-macros, mag, calcium, B vitamins (except B12), cholesterol, zinc, FSV, vitamin C

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13
Q

which part of small intestine has most potential for intestinal adaptation?

A

ileum (then colon), duodenum and jejunum has least adaptation potential

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14
Q

goals for UOP and urine Na in SBS

A

UOP >1 L/day
Urine Na >20 mEq/L

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15
Q

how can hypomagnesemia lead to hypocalcemia?

A

impaired PTH release

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16
Q

approaches to decrease PNALD risk in SBS

A

trophic EN, cyclical PN, use of ILEs with lower soybean oil content, close monitoring of mineral toxicities

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17
Q

nephrolithiasis is a risk in SBS patients with or without a colon in continuity?

A

with

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18
Q

why is nephrolithiasis a risk in SBS in those with colon in continuity?

A

-dietary oxalate usually binds to Ca and is excreted via stool
-HOWEVER, in presence of fat malabsorption > fat present in colon > calcium binds to fat > oxalates absorbed in blood

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19
Q

nephrolithiasis nutrition management

A

low fat, low oxalate, high calcium, proper hydration

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20
Q

why is metabolic bone disease a risk in SBS?

A

poor calcium and vitamin D absorption and secondary hyperparathyroidism

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21
Q

what are important considerations of fluid components in SBS? why are these important to consider?

A

osmolality, sodium content, glucose content
*b/c inappropriate fluids will exacerbate fluid losses in SBS

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22
Q

are commercial sports drinks an acceptable ORS in SBS?

23
Q

what type of bowel resection/anastomosis location should have ORS as primary hydration source?

Study These Flashcards
A

end jejunostomy

24
Q

pts with <___% of colon may benefit from ORS

25
fluid in SBS should be iso-osmolar, hyperosmolar, or hypo-osmolar?
iso-osmolar (isotonic)
26
examples of iso-osmolar/isotonic fluids for SBS
-homemade or commercial ORS -milk -diluted juice (at least 50% water) -some EN formulas
27
examples of hyperosmolar/hypertonic fluids for SBS
-fruit juice -sugar containing soft drinks and powdered drink mixes -ONS (Ensure, Boost, CBE)
28
examples of hypo-osmolar/hypotonic fluids for SBS
-water -sugar free soft drinks and powdered drink mixes -decaf tea and coffee
29
which type of fluids should be avoided in all types of SBS?
hyperosmolar/hypertonic fluids
30
hypo-osmolar/hypotonic fluids should be restricted in which type of SBS/anastomosis? what is restriction limit?
end jejunostomy restrict to 4-6 oz/day
31
energy needs in SBS
35-45 kcal/kg (may need up to 60 kcal/kg) *for both with colon in continuity and end jejunostomy
32
SBS definition
<100-150 cm remaining small bowel WITHOUT colon OR 50-70 remaining small bowel WITH colon
33
meal/eating pattern recommendation for SBS
-eat 5-6 small meals evenly spaced out -pts may need to eat more than pre SBS due to hyperphagia to compensate for potential nutrient malabsorption
34
What % of kcals should CHO make up for SBS pt with colon in continuity?
50-60% total kcals
35
What % of kcals should CHO make up for SBS pt with end jejunostomy?
20-40% total kcals
36
why should simple sugars be limited in SBS?
diet high in simple CHOs exerts high osmotic load, pulling water into lumen and increasing fluid/nutrient losses
37
should lactose be restricted in SBS?
no, unless demonstrates intolerance lactose = dairy products ie good protein and Ca sources
38
protein needs in SBS
1.5-2 g/kg (or 20-30% total kcals)
39
What % of kcals should fat make up for SBS pt
20-30% total kcals
40
What % of kcals should fat make up for SBS pt with end jejunostomy?
40-60% total kcals
41
when may fat restriction be necessary in SBS?
if pt has intact or partial colon if bile insufficiency contributing to diarrhea is suspected (usually when >100 cm of ileum resected)
42
fiber recommendation in SBS
10-15 g/day (adjust per pt tolerance) *5-10 g/day if stool output >3 L/day
43
EN should be stopped in SBS patients if output > ____ L/d
>2 L/d
44
which EN administration method and location is preferred in SBS?
slow continuous infusion into stomach preferred over small bowel to improve nutrient interaction and optimize absorption
45
EN formula recommendation in SBS
isotonic polymeric formula (avoid elemental formulas d/t hypertonicity, no evidence)
46
what is the use for obtaining random urine Na concentrations in SBS?
can be used to monitor hydration status and detect Na depletion
47
what does urine Na <5-10 mmol/L in SBS mean?
maximal Na conservation and thus Na depletion
48
what urine Na in SBS indicates Na depletion?
<5-10 mmol/L
49
urine Na should maintain >___ mmol/L in SBS pts
>20 mmol/L
50
how often should bone density assessments (such as DEXA) be done in SBS pts?
every 2-3 years (annually if osteoporotic)
51
energy goal in SBS before weaning PN
pt should meet at least 80% of energy goal without symptoms that limit PO intake
52
when weaning PN in SBS pts, weight should not decrease more than _____ kg between PN reductions
1.5 kg
53
which acid/base complication is most common in pts with SBS and SIBO?
metabolic acidosis
54
what is the optimal sodium concentration of ORS to promote jejunal absorption?
90-120 mEq/L
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