Deficiency of which of the following vitamin in most commonly seen in short bowel syndrome with ileal resection –
First, I remember that the ileum is part of the small intestine. The main functions of the ileum include absorbing bile salts and vitamin B12. Bile salts are crucial for fat digestion, but in short bowel syndrome, especially after ileal resection, the absorption of these components is impaired.
Vitamin B12 is absorbed in the terminal ileum via the intrinsic factor. If the ileum is resected, B12 can't be absorbed properly, leading to deficiency. Other vitamins like fat-soluble ones (A, D, E, K) are absorbed in the proximal small intestine, so they might be affected if the resection is more extensive, but in isolated ileal resection, B12 is the primary concern.
Looking at other options, maybe folate? Folate is absorbed in the proximal jejunum and ileum. If the ileum is gone, there's some loss, but B12 is more specific. Also, water-soluble vitamins like B1 or C are absorbed in different parts. So B12 deficiency is the key here.
Wait, the question says "most commonly seen". Since B12 is specifically absorbed in the ileum, and ileal resection removes that site, B12 deficiency is the most common. Other vitamins may be affected but not as directly. So the correct answer should be B12.
**Core Concept**
The terminal ileum is the primary site for vitamin B12 absorption via intrinsic factor-mediated endocytosis. Ileal resection in short bowel syndrome disrupts this process, leading to deficiency. Fat-soluble vitamins (A, D, E, K) are absorbed in the proximal small intestine, making them less affected in isolated ileal resection.
**Why the Correct Answer is Right**
Vitamin B12 deficiency occurs due to loss of the ileal mucosa, which binds intrinsic factor–vitamin B12 complexes. Without this site, B12 cannot be absorbed, leading to megaloblastic anemia, neuropathy, and neurological deficits. Parenteral B12 replacement is required in such cases.
**Why Each Wrong Option is Incorrect**
**Option A:** Vitamin A deficiency is more common in proximal small bowel resection, not isolated ileal loss.
**Option B:** Vitamin D deficiency typically occurs with malabsorption in the jejunum or due to fat malabsorption, not ileal resection alone.
**Option C:** Folate deficiency arises from jejunal resection or malabsorption, as folate is absorbed in the proximal small intestine.
**Clinical Pearl / High-Yield Fact**
Remember the **"ileum = B12"** rule: The terminal ileum is uniquely responsible for B12 absorption. Ileal resection always raises concern for B12 deficiency, regardless of other vitamin status.
**Correct Answer: D. Vitamin B12**