. Which are the most likely etiologies of this patient’s iron deficiency anemia?
(pick all that apply)
occult blood loss due to anastomotic ulceration at the gastro-jejunal anastomosis
Correct! Anastomotic ulceration after Roux en Y gastric bypass is a possibility. Smoking or use of non steroidals (NSAIDS) , H pylori infection and surgical factors including a larger, less proximal gastric pouch with more of the acid secreting parietal cells found in the antrum, are all risk factors for anastomotic ulcers
Decreased absorption of oral iron due to bypassed duodenum
Good choice! The incidence of iron deficiency-related anemia is estimated to be between 5-54% after RYGB surgery. Risk is higher in premenopausal females, and those with a history of peptic ulcer disease. Iron deficiency occurs largely due to bypass of the duodenum and proximal jejunum where iron absorption occurs
New colorectal cancer
Try again! RY gastric bypass does not increase the risk of colon cancer, and the patients young age and lack of symptoms, make new colorectal cancer a less likely cause of her anemia.
Impaired iron absorption due to reduction in gastric acid after bypass surgery
good choice! Acid improves the oral absorption of iron, thus hypochlorhydria after RYGB due to resection of the antrum which contains a high concentration of acid secreting parietal cells, can reduce iron absorption.
Small intestinal bacterial overgrowth (SIBO)
Try again! Small intestinal bacterial overgrowth (SIBO) can occur post RYGB or intestinal surgery, however it does not cause iron deficiency anemia.
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