q 9

[Anonymous]

Pancytopenia, macrocitosis, hypersegmente neutropfiles, megaloblastic hyperplasia of bone marrow and impaired absorption of B12 vitamin not corrected by intrinsic factor are abnormalities most likely associated with:

A- blind loop syndrome
B- anti intrinsec factor antibodies
C- Giardia lamblia infetion
D- absolute vegetarian diet

[Potatooo]

B?

[Anonymous]

A- blind loop syndrome

B12 deficiency type differentiation: use Schilling test

Abnormal absorption of B12 correctable by intrinsic factor --> anti-IF antibody (pernicious anemia)

Impaired absorption not corrected by IF --> intestinal malabsorption (Chron's blind loop)

Normal absorption --> B12 deficiency due to strict vegtarians

if corrected after antibiotic therapy --> patient has bacterial overgrowth

if corrected with addition of pancreatic extract followed by B12 --> chronic pancreatitis

folate can correct B12 deficiency, but not neurological abnormalities, so u need to give IM B12.


ref: kaplan path by goljan sec 2 pg 8

[Anonymous]

step 1, i have the kaplan review books, but couldn't find anything about "blind loop" in the GI path section. Please help! Thanks alot! :)

[Anonymous]

sorry about the confusion. i didn't relate that term from kaplan but had heard it somewhere before. after looking thru my notes, i couldn't find the term either, so i searched the web and found this:

Blind loop syndrome occurs when part of the intestine becomes blocked, so that digested food slows or stops moving through the intestines. This causes too much bacteria to grow in the intestines and causes problems in absorbing nutrients.

Causes, incidence, and risk factors :
When a section of the intestine is blocked by blind loop syndrome, bile salts needed to digest fats become ineffective, resulting in fatty stools and poor absorption of fat and fat-soluble vitamins. Vitamin B12 deficiency may occur because the extra bacteria which develop in this situation use up all of the vitamin.

The initial treatment generally involves antibiotics for the bacterial overgrowth, along with vitamin B12 supplementation. If antibiotics are not successful, surgical correction of the obstruction to allow better flow of food through the intestine may be considered.



its basically malabsorption that will cause bact overgrowth, so it won't be corrected by adding IF. instead u will need to give antibiotics.


ref: medline plus

[Anonymous]

thanks for your reply step1, i wonder how come kaplan doesn't have info like that since it's important to our step. You have any clues? Thanks!