1. Short bowel Tutoring
By Alaina Darby

2. Weaning from PN is not possible
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. How would you describe her prognosis?
Prolonged PN is likely
Weaning from PN is not possible
Adaptation makes PN weaning less likely
No adaptation will occur a

3. 40 cm small intestine + 50 cm colon
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. What is her expected functional bowel length remaining?
40 cm small intestine + 50 cm colon
100 cm small intestine + 50 cm colon
40 cm small intestine + without colon
100 cm small intestine + without colon c

4. GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. What is her expected percentage of functional bowel length remaining?
35% small intestine
45% small intestine
55% small intestine
65% small intestine a

5. Percent of bowel remaining Illeocecal valve removal
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following improves her prognosis?
Age
Resected area
Percent of bowel remaining
Illeocecal valve removal a

6. Types of resectioning

7. Length and PN weaning Expected bowel length
Length of small intestine needed to wean from PN
Age
Small intestine
Colon
19-27 week gestational age
115
27-35 week gestational age
172
>35 week gestational age
250 50
Adult
600
150
Without IC valve/colon
With IC valve/colon
Infant
30-40
15-20
Adult
100 60

8. 26 weeks: 115 cm of small intestine
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed
26 weeks: 115 cm of small intestine
75/115 = 65% removed (35% remaining)
= 40 cm remaining
Jejunostomy: End functional ostomy at jejunum
This means that ileum, IC valve, and colon are lost!!!
AKA… bad! b

9. Removal of additional 25 cm of small intestine now
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following would most increase her mortality risk?
Removal of additional 25 cm of small intestine now
Removal of additional 25 cm of small intestine in 2 weeks
Pancreatic failure
Gall stone/gallbladder obstruction d

10. GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following vitamins would she most likely have issues absorbing?
Folate
Thiamine
Cyanocobalamin
Niacin
c (B12)
a (B9), b (B1), d (B3)

11. Complex carbohydrates Simple carbohydrates Protein Fatty acids
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Absorption of which of the following nutrients would be most affected?
Complex carbohydrates
Simple carbohydrates
Protein
Fatty acids a

12. GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following might increase?
Sodium
Calcium
Phosphate
Potassium d

13. Sites of absorption

14. GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which medication would be most helpful within the first week?
Ondansetron
Ranitidine
Rifamixin
Loperamide b

15. Combat metabolic alkalosis Prevent cholelithiasis Prevent infection
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. What would be your primary goal within the first week?
Replace fluids
Combat metabolic alkalosis
Prevent cholelithiasis
Prevent infection a

16. GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. After, surgery, when would you consider starting enteral feeds?
2 days
2 weeks
2 months
2 years b

17. Total enteral nutrition Partial enteral nutrition
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following is necessary for bowel adaptation?
Total enteral nutrition
Partial enteral nutrition
Total parenteral nutrition
Partial parenteral nutrition b

18. Increased peptide transport Increased brush border enzymes
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following is not a functional change that occurs?
Increased peptide transport
Increased brush border enzymes
Increased intestinal motility
Increased nutrient absorption c

19. GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following must always be supplemented in this patient?
B12
Bile salts
Calcium
Bicarbonate a

20. Complex carbohydrates Simple carbohydrates Protein Fatty acids
GJ is a 26 week GA infant with NEC who has had a end jejunostomy with 75 cm of her small intestine removed. Which of the following might be a preferred form of calories in the adaptation phase?
Complex carbohydrates
Simple carbohydrates
Protein
Fatty acids d

21. High mortality risk with likely weaning off of PN
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. What is the expected outcome for this patient?
High mortality risk with likely weaning off of PN
High mortality risk without likely weaning off of PN
Low mortality risk with likely weaning off of PN
Low mortality risk without likely weaning off of PN c

22. Jejunum to assume some B12 absorption
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. What type of adaptions do you expect?
Jejunum to assume some B12 absorption
Jejunum to assume some bile salt reabsorption
Ileum to assume complex carbohydrate fermentation
Ileum to assume some calcium absorption d

23. 37 weeks: 250 cm of small intestine
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact.
37 weeks: 250 cm of small intestine
100/250 = 40% removed (60% remaining)
= 150 cm remaining
100 cm (2/5) jejunum and 150 cm (3/5) ileum initially
50 cm of jejunum and 100 cm of ileum remaining b

24. Fecal occult stool test Fecal fat testing/identification Stool pH test
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. Which of the following is not used to assess absorption?
Fecal occult stool test
Fecal fat testing/identification
Stool pH test
Reducing substance stool test a

25. Decrease dietary oxalate Avoid refined carbohydrates Ursodiol
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. He presents with lower back pain. Which would you recommend?
Decrease dietary oxalate
Avoid refined carbohydrates
Ursodiol
Cholecystokinin a

26. Decrease dietary oxalate Avoid refined carbohydrates Ursodiol
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. He now has a headache and trouble walking properly. What should you suggest?
Decrease dietary oxalate
Avoid refined carbohydrates
Ursodiol
Cholecystokinin b

27. FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. Which of the following would lead to fat malabsorption?
Lactic acidosis
Bacterial overgrowth
Cholestasis
Hyperoxaluria b

28. Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. Which of the following would be most likely should he develop diarrhea?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis c

29. FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. Which of the following would you be least likely to need to supplement with diarrhea?
Magnesium
Calcium
Bicarbonate
Sodium b

30. Metabolic bone disease
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. Which of the following would be least likely in this patient?
Lactic acidosis
Cholelithiasis
PNALD
Metabolic bone disease c

31. FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. Which of the following trace element abnormalities would be less likely in this patient than a patient on PN?
Zinc deficiency
Copper deficiency
Zinc accumulation
Copper accumulation d

32. Neurological deficits
FR is a 37 week GA infant with NEC who has had 50 cm of jejunum and 50 cm of ileum resected. The colon is still in continuity and the ileocecal valve is intact. He has been successfully weaned from PN and is now 5 yo. Which of the following trace element abnormalities would be least likely in this patient?
Night blindness
Clotting disorders
Osteomalacia
Neurological deficits b