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• W2000997878 abstract "FOR MOST PATIENTS the early period after establishment of an ileostomy is marked by salt and water depletion. For most patients the fluid and electrolyte imbalances become manageable within a few days; however, a small proportion of patients maintain outputs of ileal fluid that are greater than 1 L per day. In the 1960s there had been a considerable amount of investigation to characterize the clinical course of adaptation after ileostomy. Recent work has focused on identifying the systemic mechanisms by which the organism adapts to the loss of its colon. However, little has been done to clarify the mechanisms by which the upstream small intestine increases its efficiency in absorbing NaCl and H2O after ileal diversion. Here I review these prior studies and findings and outline experimental approaches that have evaluated mechanisms of salt and water absorption by upstream segments of small intestine after diversion of the ileal contents distally. CLINICAL CHARACTERISTICS OF ADAPTATION AFTER ILEAL DIVERSION Virtually all clinical reviews have indicated that patients with permanent ileostomies eventually have a high level of satisfaction with the function of the stoma. Of course, most of these studies have been conducted in patients who were suffering from acute symptoms of chronic ulcerative colitis before proctocolectomy and ileostomy. Thus, it has been argued that the improvements in satisfaction and quality of life indexes were no more than a comparison between states of illness and wellness. Nevertheless, a number of lessons have been learned from this group of patients (Table I).1-3 These include the following: First, the average patient empties the ileostomy bag, on average, 6 to 8 times per day.1 Second, despite the best techniques in stoma construction and care, skin excoriation affects between 30% and 40% of patients on a regular basis, and these effects are attributable to the volume and caustic nature of the ileal effluent.1,2 Third, certain foods, including those containing high levels of fat or fiber, often cause increased levels of ileostomy output.4-7 Fourth, ileostomy output is associated with insignificant or low levels of nutrient malabsorption, major vitamin deficiencies or metabolic derangements leading to anemia, mineral bone disease, gallstones or renal stones, unless it is also accompanied by resection of major portions of the small intestine.8-12 Adaptation to ileal diversion" @default.
• W2000997878 created "2016-06-24" @default.
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• W2000997878 date "2001-02-01" @default.
• W2000997878 modified "2023-09-26" @default.
• W2000997878 title "Adaptation to ileal diversion" @default.
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• W2000997878 doi "https://doi.org/10.1067/msy.2001.107980" @default.
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