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Diagnosis:

The diagnosis of short bowel diseases is based on a combination of a physical exam, laboratory tests and imaging exams.

Medical History and Physical Examination:

The first step in diagnosing and properly treating short bowel syndrome is an in-depth interview with the patient and a physical exam. During the interview, the gastroenterologist gathers details about the patient’s conditions and surgical history. It is essential that patients bring all previous surgical reports for the physician to review during the evaluation.

Laboratory Tests – Complete blood count (CBC)

A Complete Blood Count (CBC) and a Complete Metabolic Panel (CMP) are both blood tests that provide important information about your health, but they focus on different aspects of your blood and body chemistry.

Complete Blood Count (CBC): A CBC measures different components of your blood. It includes the following key components:

  1. Red Blood Cells (RBCs): These carry oxygen from the lungs to the rest of the body.
  2. White Blood Cells (WBCs): These are involved in the immune response and help fight infections.
  3. Platelets: These are responsible for blood clotting.
  4. Hemoglobin: The protein in red blood cells that carries oxygen.
  5. Hematocrit: The ratio of the volume of red blood cells to the total volume of blood.

A CBC is often used to diagnose and monitor conditions such as anemia, infections, and blood disorders.

Complete Metabolic Panel (CMP): A Complete Metabolic Panel focuses on the chemical balance in your body and provides information about the status of your organs and metabolism. It typically includes tests for:

  1. Glucose: Blood sugar levels.
  2. Electrolytes: Such as sodium, potassium, and chloride.
  3. Kidney function: Blood urea nitrogen (BUN) and creatinine.
  4. Liver function: Enzymes and proteins produced by the liver, such as alanine aminotransferase (ALT) and albumin.

The CMP helps assess the health of your organs, including the liver and kidneys, and provides information about your body’s overall metabolic state.

In summary, while a CBC focuses on blood cell counts and related parameters, a CMP provides information about the chemical balance and function of organs in your body. Both tests are valuable tools in assessing your overall health.

These tests are done on a part of the blood called serum, and they assess electrolyte levels, as well as chemicals related to metabolism and other digestive functions.

Additional specific laboratory tests include:

  1. Pre-albumin to gauge acute nutritional status
  2. Liver enzymes: AST, ALT, GGTP
  3. Protein/PTT/INR

Mineral levels such as:

  • Iron/TIBC
  • Zinc
  • Magnesium
  • Phosphorus
  • Chromium

Vitamin levels including:

  • Vitamin A
  • Vitamin E
  • 25 OH-Vitamin D
  • B12/Folate

Monitoring for bacterial overgrowth with:

  • D-lactate
  • Urine indicators
  • Glucose breath hydrogen test
  • Sedimentation rate
  • Stool calprotectin

In simpler terms, these tests help doctors assess various aspects of your blood and body chemistry, checking for conditions like anemia, nutritional status, liver function, and levels of essential minerals and vitamins. They also monitor for bacterial overgrowth in the digestive system.

Fecal fat test

In short bowel syndrome (SBS), the fecal fat test is a diagnostic tool used to measure the amount of fat present in a person’s stool. This test helps assess fat malabsorption, which is common in SBS due to the reduced length of the small intestine. Elevated levels of fat in the stool indicate malabsorption, and the test aids in managing nutritional interventions for individuals with SBS.

Imaging Studies

The evaluation of short bowel syndrome may involve various imaging studies to provide insights into the patient’s condition.

X-rays: These produce a two-dimensional view of the abdomen, aiding physicians in identifying abnormalities, such as obstruction, in the small bowel.

Barium Upper GI X-rays: In this procedure, patients ingest a liquid containing barium, which coats the intestines. This helps highlight abnormal structures or obstructions in the small bowel. Patients are required to refrain from consuming food and beverages before the test.

CT Scans: These generate two-dimensional images of the abdomen, offering a detailed look at potential issues in the small intestine.

Bone Densitometry: A bone densitometry test, also known as bone density testing or dual-energy x-ray absorptiometry (DEXA or DXA), is a medical diagnostic procedure used to measure the density of bones. The test is commonly performed to assess the strength and mineral content of bones, particularly in the spine, hip, and forearm.

Endoscopy or Colonoscopy: Specialists can examine the duodenum, upper part of the jejunum (proximal jejunum), and the lowest parts of the small intestine (terminal ileum) using an endoscope or colonoscope. Before these procedures, patients receive a mild sedative. A thin tube with a light source and camera is passed down the throat and through the stomach (endoscopy) or up through the rectum (colonoscopy). It’s important to note that neither test covers the entire small bowel.