Thread by @A_ChiplunkerMD

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 1/8 Anatomy & Definitions
✂️ < 200cm SB remaining 🟰#SBS
✂️ > 200cm SB remaining ➕intestinal failure (need for IVF/PN, multiple vitamin deficiencies) 🟰#SBS too
✂️ Intraop bowel 📏 GREATLY appreciated!
✂️ Colon in continuity?
🔑 Anatomy guides diet & treatment recommendations

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 2/8 Bowel Adaptation takes TIME
⏳Stage 1 (1-3mo post op): ⬆️ output, ⬆️ gastric acid
⏳ Stage 2 (3mo-1yr): ⬆️PO intake (crucial for adaptation), ⬇️ parenteral support
⏳ Stage 3 (1-2yrs ➕): Max adaptation
🔑Set appropriate expectations for patients, caregivers and providers!

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 3/8 Control Diarrhea - 🐢🚫🐇
🛑 Loperamide 4mg QID & Diphenoxylate/atropine 2 tabs QID (🍽️&🛌)
🛑 Take 30-60min before 🍽️ for optimal 🐢
🛑 🚫 Bile acid binders if > 100cm SB gone
🔑 👀for obstructive symptoms and adjust accordingly

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 4/8 Decease secretions
🚱 Octreotide (short or long-acting), can go in PN
🚱 Proton pump inhibitor PO
🚱 H2Ri (PO or PN)
🚱 Clonidine patch (if BP tolerates)
🔑 Useful adjuncts when 🐢 strategy not enough

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 5/8 Eat to live well & control symptoms
🧂 Drink ORS #GIPhysiologyFlashback
🧂Water & Sports drinks 🚫 enough
🍴 Diet composition should vary by anatomy (less fat for colon in continuity, more carbs for no colon)
🔑 RDN partnership is crucial!

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 6/8 Fatten up those villi!
🏋🏻 Teduglutide can be safely used in #SBSinIBD
tinyurl.com/3fp5cym6
🏋🏻 #IBD should be in remission
🏋🏻 Obstructive symptoms can be managed with dose and/or interval reduction
tinyurl.com/2famyvmd

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 7/8 Get that #IBD under control
🔥Optimize medications (TDM, combination therapy)
🔥 Extended release medications may not be well absorbed
🔥 Consider SQ/IV therapies if any concern about absorption
🔑 #IBD and #SBS teams need to 🤝 closely in #SBSinIBD

@MondayNightIBD @LoriPlung @SwapnaSpeaks @DrTonySquillaro @GalanteMD @ColleenWebbRD @SchwartzbergMD @Waseem_AhmedMD @Dr_PedGI @seanpattyp @kupffercell4 @Paulinunezfigue @ReicheWill 8/8 Healthy Living for optimal QoL
✅ Fat soluble vitamins & trace minerals
✅ Replete & monitor often
✅ Fat mass repleted 1st 🟰⬆️visceral fat & ⬆️ metabolic syndrome risk factors
🔑 #SBS & #IBD patients living longer & other chronic conditions will arise over time