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Kaplan Qbank USMLE



Author7 Posts
  #1

A 45-year-old woman was diagnosed with chronic progressive ulcerative colitis at age 32. The medical treatment options for her condition have been exhausted, and she is referred to a surgeon for total colectomy. This treatment can predispose a pt to which of the following?

(A) dehydration
(B) Protein deficiency
(C) Bleeding tendencies
(D) Pernicious anemia


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There are many things in this world that can’t be changed no matter how hard you try. That’s why you must not hesitate when the time comes where you have to give it all you’ve got.

  #2

c

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  #3

B

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  #4

bleedin tendencies is when ileium and colon are removed as no more vit K will be absorbed from ileum and COLON both...
there are bacteria in ileum as well smiling face dear mikky...dear silver...
proteins are absorbed from small intestine... smiling face jejunum is there...
most of the WATER from secretions is absorbed in colon...
secondly the ileostomy is a HIGH FLOW conduit...so there is MROE loss of fluid...
DEHYDRATION wud be my choice

A

  #5

answer is a. ileostomy leads to high output fistula leading to dehydration. but it is self limiting and improves over time.

  #6

Should be A

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  #7

Bacterial action in the colon is responsible for the production of several vitamins. In particular, colonic bacteria produce a large quantity of vK. The amount of vK in the diet is usually insufficient to maintain adequate blood coagulation. Therefore, removal of the colon would predispose an individual to vK deficiency and resultant bleeding tendencies

concept tested: bacterial action in the large intestine is responsible for the majority of vK absorbed

SmokyWaters wrote:
bleedin tendencies is when ileium and colon are removed as no more vit K will be absorbed from ileum and COLON both...
there are bacteria in ileum as well smiling face dear mikky...dear silver...


This statement illustrates poor understanding of intestinal histology. The small intestine is sterilised, especially ileum, albeit its connection to the cecum. Ileum is enriched with paneth cells, M cells, and lymphoid organs such as payer’s patches and lymph nodes, all these contribute to the sterilization. Ileum is responsible for the absorption of fat and lipophilic vitamin but as the answer stated, vK derived from normal dietary products is not sufficient for maintenance of blood coagulation, unless ofc you live in Norway or alike and eat loads of salmon.

Dehydration is a good answer although not the best bc hydration can be sufficiently regulated by the patient because everyone can feel thirst, but vK regulation requires physician counselling.


Edited by Jackofknives on 10/22/07 - 02:37 AM

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