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Pediatric Short Bowel Syndrome Workup

  • Author: Carmen Cuffari, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
 
Updated: Aug 15, 2016
 

Laboratory Studies

See the list below:

  • Perform standard hematologic and biochemical studies in all children with short bowel syndrome (SBS). Each institution follows its own specific guideline. The following list is not intended to represent an exhaustive list of laboratory evaluations:
    • Electrolytes, BUN, creatinine, calcium, magnesium, phosphorous - Biweekly in both the initial phase and the late period or at the time of presentation for instability
    • Comprehensive panel, CBC count, triglycerides, cholesterol - Weekly in both the initial phase and the late period or at the time of presentation for instability
    • Folate, vitamin B-12, vitamin E, copper, zinc, selenium - Monthly in both the initial phase and the late period or at the time of presentation for instability
    • Carnitine
  • Microbiology
    • Any suspicion of sepsis necessitates blood cultures. Children with short bowel syndrome are susceptible to intestinal bacterial translocation, with the central line as the most likely source of seeding. They are also susceptible to translocation of skin flora such as Staphylococcus species.
    • Obtain blood cultures from both the central and peripheral sites.
    • Consider opportunistic infections, including fungal infections, in the differential diagnosis of a child presenting with sepsis. Obtain a urinalysis and blood culture in these children specifically to search for fungal infection.
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Imaging Studies

See the list below:

  • Imaging studies are needed to assess for potential complications, including the following:
    • Infection
      • Abdominal ultrasonography to search for fungal balls in the kidney
      • CT scanning of the abdomen to identify sepsis
      • Ultrasonography of Broviac tip
    • Bowel obstruction
      • Plain radiography of the abdomen (see image below)
        Small-bowel obstruction caused by intussusception Small-bowel obstruction caused by intussusception in a 5-month-old patient is visible on plain radiograph.
      • Barium imaging of the bowel
    • Liver disease
      • Abdominal ultrasonography to study the liver, biliary tract, and spleen, as well as assess for the presence of ascites
      • Abdominal ultrasonography with Doppler to assess portal flow
    • Potential liver or bowel transplant
      • Volumetric CT scanning of the liver
      • Possible angiography
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Procedures

Children with short bowel syndrome may require laboratory procedures, including the following:

  • Upper endoscopy to assess for peptic ulcer disease and possible signs of liver disease (eg, esophageal varices, hypertensive gastropathy)
  • Liver biopsy to evaluate the patient for signs of total parenteral nutrition (TPN)-related liver disease (This is rarely performed unless the presentation is unusual.)
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Contributor Information and Disclosures
Author

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, FAAP Professor of Pediatrics, Medical College of Georgia, Georgia Regents University; Chief, Division of Neonatology, Director, Fellowship Program in Neonatal-Perinatal Medicine, Director, Transport/ECMO/Nutrition, Vice Chair, Clinical Research, Department of Pediatrics, Children's Hospital of Georgia

Jatinder Bhatia, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, Academy of Nutrition and Dietetics, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Gerber.

Additional Contributors

Jorge H Vargas, MD Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, University of California, Los Angeles, David Geffen School of Medicine; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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Small-bowel obstruction caused by intussusception in a 5-month-old patient is visible on plain radiograph.
 
 
 
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