Surgery MCQs Q39

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SURGERY • GI PHYSIOLOGY

A patient with a history of extensive small bowel resection develops chronic diarrhea, weight loss, and fatty stools (steatorrhea). He is also found to have recurrent renal stones.

Which of the following is NOT a feature of short bowel syndrome?

A Diarrhea

B Hypogastrinemia

C Weight loss

D Steatorrhea

E Renal oxalate stones

The correct answer is Hypogastrinemia.

Decoding the Stem

1

CLUE "Short bowel syndrome physiology"

TRANSLATION Identify the incorrect feature of malabsorption due to reduced surface.

Explanation

❌ Correct “EXCEPT” Option (Hypogastrinemia): In short bowel syndrome, gastrin levels are typically increased (hypergastrinemia), not decreased. This occurs because the loss of absorptive surface leads to malabsorption and feedback hormonal changes that stimulate gastrin secretion.

✅ True Features of Short Bowel Syndrome:

→ Diarrhea: Due to decreased absorption of water and nutrients.

→ Weight loss: Due to chronic malabsorption of calories.

→ Steatorrhea: Fat malabsorption leads to unabsorbed fat in the stool.

→ Renal oxalate stones: Fat binds calcium, leaving oxalate free for hyperabsorption.

🧠 High-Yield Pearls

✔ Short bowel = Hypergastrinemia (classic MCQ trap).

✔ Fat malabsorption → Steatorrhea + Oxalate stones.

✔ Key consequences: Electrolyte imbalance & Vitamin deficiencies (A, D, E, K).

Integrated Clinical Questions

1. Most common cause?

→ Extensive small bowel resection (Crohn’s, ischemia).

2. Most important vitamin deficiency?

→ Fat-soluble vitamins (A, D, E, K).

3. Why diarrhea occurs?

→ Reduced absorptive surface + bile acid malabsorption.

4. Treatment cornerstone?

→ Nutritional support (TPN if severe).

5. Key complication of ileal loss?

→ Bile salt malabsorption → fat malabsorption.

⚡ Exam Pearls

• • Hypogastrinemia = false statement (Short bowel = hypergastrinemia).
• • Always associate: Fat malabsorption → steatorrhea + oxalate stones.
• • High-yield concept in GI physiology exams.

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