Intestinal failure is a challenging, emerging field that has beenthe subject of much research and debate in recent years and hasonly recently become widely accepted as a distinct clinicalsyndrome. This comprehensive book provides an in-depth review ofscientific theory and clinical practice relating to intestinalfailure with specific emphasis on assessment and management as partof a multidisciplinary team. Compiled by an internationallyrecognised editorial team, the book provides a practical how-toguide to the management of adult and pediatric patients withintestinal failure, focusing on quality-of-life issues that are atthe heart of patient care. World experts from centers of excellence share their clinicalexperience and expertise, offering the first ever authoritativeresource on intestinal failure All aspects of patient management are covered, from diagnosisand medical and surgical management (including transplantation) tonutritional consideration and psychosocial aspects of care Numerous illustrations, flow diagrams and summary boxescomplement the text and emphasize important concepts, providing anaccessible approach to this complex field This landmark book is essential reading for anygastroenterologists, surgeons, transplant teams or clinicalnutritionists involved in the care of patients with intestinalfailure.

A complex disease entity, intestinal failure (IF) has only recently become accepted as a distinct clinical syndrome. Improvements across a wide range of disciplines-including critical care and organ transplantation as well as surgical, medical, and nutritional therapies-have led to a steady rise in survival and quality of life for patients with IF.

Adult Short Bowel Syndrome: Nutritional, Medical, and Surgical Management serves as a practical guide to the medical, surgical and nutritional care of complex patients with Short Bowel Syndrome (SBS), providing information on SBS with the most up-to-date, evidence-based data available. Additionally, the book presents global perspectives and highlights emerging areas of research that are influencing the care of patients with SBS. Intended for nutritionists, dieticians, physicians (specifically, general practitioners, gastroenterologists, and surgeons), nurse practitioners, pharmacists, students and researchers, this book serves as a quick reference on the medical, surgical and nutritional care of complex patients with short bowel syndrome. - Presents emerging areas of research related to Short Bowel Syndrome (gut microbiome, pre/probiotics), as well as current applications in clinical practice - Compiles an overview, classification and complications of the Short Bowel Syndrome disease state - Contains effective dietary concepts (including rationale and use of oral rehydration solutions) for managing malabsorption caused by Short Bowel Syndrome - Includes medical and pharmaceutical management techniques to compliment nutrition interventions - Discusses surgical options for consideration in patients with Short Bowel Syndrome - Highlights international perspectives on treatment and care

Short Bowel Syndrome: Practical Approach to Management is the first reference exclusively about the issues experienced by patients with a short bowel. It covers all aspects of normal and abnormal physiology, the presenting features, and outcomes, including metabolic problems, gallstones, and renal stones. It discusses both medical and surgical treatments, including intestinal transplantation. The use of growth factors, which is likely in the future to become increasingly important in promoting intestinal structural adaptation, is extensively discussed. Special emphasis is given to the psychosocial aspects of the quality of life of patients, including support groups. Emphasis is also given to the importance of an experienced multidisciplinary team in caring for these patients. This book is particularly timely given the recent advances in the management of Short Bowel Syndrome, including the availability of pharmacologic agents to enhance intestinal absorption, refinements in parenteral nutrition, and surgical procedures designed to eliminate the need for parenteral nutrition support. The goal of this international, interdisciplinary book is to bring the subject of Short Bowel Syndrome to a wide audience. A wide range of specialists have contributed to this book to provide various viewpoints on the state-of-the-art care of those with this condition.

Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

This fully revised new edition focuses on the clinical, diagnostic, and therapeutic aspects of conditions encountered by the coloproctologist and gastroenterological surgeon, who are faced with an increasing number of precise and specific treatment modalities.