High output ileostomy Ileostomy diarrhea

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Ileostomy. Total colectomy and minimal resection of terminal ileum (i.e. 10cm) - ileostomy output: 400-600g/dayLonger resection of terminal ileum -ileostomy output: larger, usually 1000g/day. Pathophysiology(1) . reduced small bowel surface area for absorption of nutrients with more transit of intestinal contentloss of mucosa containing brush border hydrolases affected carbohydrate digestion- non-absorbed sugars- osmotic diarrhea, rarely severe metabolic acidosis (lactobacilli convert the 29827
High output ileostomy Ileostomy diarrhea

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1. High output ileostomy (Ileostomy diarrhea) 2002-12-16 Ri ???

2. Ileostomy Total colectomy and minimal resection of terminal ileum (i.e. 10cm) - ileostomy output: 400-600g/day Longer resection of terminal ileum -ileostomy output: larger, usually 1000g/day

3. Pathophysiology(1) reduced small bowel surface area for absorption of nutrients with more transit of intestinal content loss of mucosa containing brush border hydrolases affected carbohydrate digestion - non-absorbed sugars - osmotic diarrhea, rarely severe metabolic acidosis (lactobacilli convert the carbohydrate to D-lactic acid)

4. Pathophysiology(2) Excessive gastric acid secretion - lowering the intraduodenal pH - inactivate pancreatic digestive enzymes stimulate peristalsis

5. Clinical manifestations Malabsorption and Diarrhea (correlate with length, location, quality of the residual bowel) Potential for dehydration, hyponatremia, hypokalemia and acidosis (inadequate reabsorb fluid and e-) Deficiencies of Fe, Na, Ca, Mg, Zn, Cu, Se, Vit B12, fat soluble Vits

7. Adaptation(1) Potential : ileum > jejunum Immediately after loss of bowel, continue for years Included : - cell hyperplasia and increase mucosal surface area - increase in bowel circumference - length and bowel wall thickness - villus height, crypt depth

8. Adaptation(2) Luminal nutrition is essential for adaptation change, and begin as soon as possible small frequent feeding enteral drip tube feeding Potential stimulants of adaptive growth - growth hormone, glutamine, soluble fiber...

9. Treatment Goal of management : Initial: - promote and maintain growth - adaptation changes in the residual bowel Eventual : - permit full enteral feeding Nutrition, medical, surgical and small bowel transplantation

10. Nutritional management (1) TPN is necessary in the early stages - cholestatic jaundice with danger of progression of hepatic cirrhosis - cyclical TPN may decrease the risk - neomycin or metronidazole may reduce harmful bacterial translocation across the gut

11. Nutritional management (2) Enteral nutrition : - low amount, continuous gastric infusion - elemental diet - contribute to adaptive growth of the small bowel

12. Medical treatment H2 blocker : reduce the possible gastric hypersecretion improve the diarrhea Loperamide hydrochloride : slow transit time and reduce secretion, but with risk of bacteria overgrowth Trophic factors in adaptation growth hormone, glutamine, other hormones...

14. Surgical treatment Not employed within 6 ~ 12 months after resection, due to widely individual variation in the potential for intestinal adaptation

15. Conclusion

16. Thanks for your attention


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