Short-bowel syndrome and intestinal failure — formative SAQs

SAQ 1 — The premature neonate with a high-output jejunostomy (10 marks, 15 minutes)

A baby born at 27 weeks gestation develops necrotising enterocolitis and undergoes a massive small-bowel resection, leaving a 35-centimetre jejunal remnant ending in a jejunostomy with the colon disconnected. On day 14 the stoma output is 60 mL/kg/day, the weight has fallen, and the conjugated bilirubin is rising on parenteral nutrition. ^[1]

a) Define short-bowel syndrome and intestinal failure, and explain why this child's end-jejunostomy configuration carries a particularly poor prognosis for enteral autonomy. (2 marks) ^[1]

b) Explain the sodium principle as it applies to this high-output stoma, and state how you would manage the stoma losses acutely. (3 marks) ^[2]

c) Outline your strategy to prevent intestinal failure-associated liver disease, naming the two dominant modifiable drivers and the lipid approaches used regionally. (3 marks) ^[5]

d) Describe the staged definitive plan for this child, including the role of enteral feeding, the timing of establishing colon continuity, and the place of teduglutide and transplant. (2 marks) ^{[1] [3]}