Aashi
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A 35-year-old woman presents to the office with complaints of intermittent diarrhea over the past few weeks. She has lost 15 to 20 lb recently, despite a healthy appetite and normal food intake. She states that she frequently has loose, bulky, and foul-smelling stools. She denies any abdominal pain, the use of alcohol, and has no recent travel history. Past medical history is significant for insulin-dependent diabetes mellitus, diagnosed at age 14. At age 20, a perforated pyloric channel ulcer was treated surgically by a Roux en Y. Besides insulin, the patient takes no other medications.
On physical examination the vital signs are normal. She is a thin, pale-appearing woman. Her abdomen is soft and nontender with no hepatosplenomegaly. Her stool is negative for occult blood. She has diminished sensation over the bilateral lower extremities. Laboratory tests show: white blood cells: 7,500/mm3, hemoglobin 9.1 mg/dL, hematocrit 30%, platelets 450,000/mm3, mean corpuscular volume 105 μm3, vitamin B12 92 pg/mL (normal 330-1,025 pg/mL), and albumin 2.5 g/dL. The patient undergoes a 72-hour stool collection and excretes 21 grams of fat/24 hours (elevated). Stool culture is negative for parasites. What can the leading cause of malabsorption in this patient be attributed to?
(A) Pancreatic exocrine insufficiency
(B) Eosinophilic gastroenteritis
(C) Bacterial overgrowth secondary to Roux en Y surgery and diabetic enteropathy
(D) Pernicious anemia
(E) Crohn's disease
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| Dr.Luck
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I'd go for crohn's dz as she has frequesnt diarrhea(chronic) & allso has fat malabsprtion due to involvement of distal illeum so b12 & bile acids malabsorption as they both are absorbed over there.
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| doc_clotaire
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D ) Pernicious anemia
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| Dr.Luck
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hey ashi, I've a question for you...how do u guys take out time to write & answer all the question in TM section...I mean I usually get tired of doin my lecture notes & stuff & don't get a chance to come in this forum & let alone answer the q given here....just wanted to know .
Thanx & GL
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| Aashi
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Buddy , i havent wasted my time typing any of these qs, they are all copy-pasted, which takes only a few secs- minutes and i do it when i take a break from my studies..and yes it may take few more minutes for u guys to answer,but one thing u shld remeber is,USMLE exams is not just abt studying ,its also abt how to apply what u studied in a clinical scenario, and for that u have to practice doing loads of standared qs...
GL
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| robin082006
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Why not C my friends?
She underwent surgery so I go with C first.
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| fox
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D
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| dr.wad
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( c )
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| Aashi
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Answer:
(C) Bacterial overgrowth secondary to Roux en Y surgery and diabetic enteropathy
Explanation:
Bacterial overgrowth can cause diarrhea and malabsorption. Both a Roux en Y limb and diabetic enteropathy can result in bacterial overgrowth. The small intestine normally contains a small number of bacteria. Bacterial overgrowth results in malabsorption secondary to bacterial deconjugation of bile salts, leading to inadequate micelle formation. This will ultimately result in decreased fat absorption with steatorrhea. Microbes and bacteria uptake nutrients, thereby reducing absorption of vitamin B12 and carbohydrates. The proliferation of bacteria directly damages intestinal epithelial cells, as well as the brush border, impairing protein absorption. Passage of malabsorbed bile acids and carbohydrates into the colon leads to an osmotic and secretory diarrhea.
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