Short-Bowel Syndrome Clinical Presentation

Updated: Dec 22, 2016
  • Author: Burt Cagir, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History

Patients with short-bowel syndrome invariably present with a history of several intestinal resections, as occurs with Crohn disease, or with a history of a major abdominal catastrophe or vascular accident, such as midgut volvulus or embolus to the superior mesenteric vessels. Pursuant to the resultant malabsorption, diarrhea (with or without steatorrhea) is an almost constant clinical finding.

Patients with short-bowel syndrome may describe significant weight loss, fatigue, malaise, and lethargy. These symptoms are protean but consistent with the diarrheic diathesis and resultant dehydration, electrolyte imbalance, protein-calorie malnutrition, and loss of critical vitamins and minerals.

Vitamin and mineral deficiencies can lead to some specific symptoms, as follows:

  • Patients with vitamin A deficiencies may report night blindness and xerophthalmia
  • Vitamin D depletion can be associated with paresthesias and tetany
  • Loss of vitamin E can cause paresthesias, ataxic gait, and visual disturbances because of retinopathy
  • A history of easy bruisability or prolonged bleeding might suggest vitamin K depletion
  • Patients reporting dyspnea on exertion or lethargy may be anemic from vitamin B12, folic acid, or iron deficiency
  • Calcium and magnesium losses can cause paresthesias and tetany
  • Patients with critically low zinc levels may describe anorexia and diarrhea
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Physical Examination

Physical examination of the patient with short-bowel syndrome can reveal many clues to the diagnosis, depending on the duration and severity of the malabsorption.

Patients who are severely protein- and energy-malnourished may present with temporal wasting, loss of digital muscle mass, and peripheral edema. The skin may be dry and flaky. The nails can feature prominent ridges, and the lingual papillae are blunted or atrophic. In children, poor growth performance is a telling feature.

The essential fatty acids are linoleic and linolenic acids. Patients with essential fatty acid deficiency experience growth retardation, dermatitis, and alopecia.

The physical features of vitamin A deficiency include corneal ulcerations and growth delays.

Patients with low levels of the B complex vitamins in general can present with stomatitis, cheilosis, and glossitis. Vitamin B1 deficiency is associated with edema, tachycardia, ophthalmoplegia, and depressed deep tendon reflexes. Vitamin B6 deficiency can cause peripheral neuropathies and seizures. Peripheral neuropathy can be a feature of B12 deficiency also.

Vitamin D depletion is associated with poor growth and bowed extremities.

Severe vitamin E deficiencies can result in ataxia, edema, and depressed deep tendon reflexes.

The physical hallmarks of vitamin K deficiency are related to derangements in hemostasis. These include petechiae, ecchymoses, purpura, or outright bleeding diatheses.

Physical clues to the presence of iron deficiency include pallor, spooned nails, and glossitis.

Zinc deficiency causes angular stomatitis, poor wound healing, and alopecia. Also, a scaly erythematous rash can erupt around the mouth, eyes, nose, and perineum.

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