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home - Small Bowel - Miscellaneous - SMA Syndrome Written by Dr Sebastian Zeki
Knowledge


Defines the pathophysiology of fluid and nutrient malabsorption,
including causes, e.g. anatomical and functional short bowel
syndrome, high output stomas, enterocutaneous fistulae and
pancreatic insufficiency

Knows how to investigate patients with malabsorption
Describes the clinical consequences of malabsorption, including
malnutrition, fluid and electrolyte disturbance and micronutrient
deficiency and anaemia and how to manage these

Describes all other causes of anaemia, including bone marrow
disorders and haemolysis

Describes the metabolism, absorption and bioavailability of iron, B12
and folate and clinical conditions and diets associated with their
deficiency

Skills
Identifies and appropriately investigates clinical features suggestive of
malabsorption

Manages fluid, electrolyte and micronutrient disturbances associated
with short bowel syndrome or high output stomas

Uses the appropriate investigations for the different types of anaemia
Behaviours
Takes a careful clinical approach to managing patients with
malabsorption and anaemia. Explains plan of management clearly to
patients and their relatives.

SMA Syndrome

Treatment:Conservative measures-As per treatment of small bowel obstruction.Surgery-Involves mobilisation of the duodenum and division of the ligament of Treitz.The jejunum is passed behind the SMA and positioned to the right of the SMA so it does not lie in the acute angle between the aorta and the SMA.Duodenojejunostomy in which the compressed portion of the duodenum is released and an anastomosis created between the duodenum and jejunum anterior to the SMA. Written by Dr Sebastian Zeki Protective fat pad under SMA gets thinner in thin patients SMA comes off aorta at L1 Duodenum crosses aorta at L3 Clinical Manifestations Presents with small bowel obstruction.Symptoms are sometimes relieved when lying in the left lateral decubitus or prone. Diagnosis-Duodenal obstruction with an abrupt cutoff in the 3rd portion occurs.-A narrow angle between the aorta and the SMA can be seen.Imaging Types include CT or MR angiography. Causes:Rapid weight loss.Scoliosis surgery.Pregnancy.Congenitally short Ligament of Treitz. = Compression of the 3rd part of the duodenum by the SMA causing intestinal obstruction due to loss of intervening mesenteric fat pad Superior mesenteric artery syndrome (=Wilkie syndrome/ Cast syndrome/ Chronic duodenal ileus/ arteriomesenteric duodenal obstruction)