A man who had undergone total gastrectomy remains well for five years. Then he develops anaemia. What is the most likely cause of this anaemia ?
**Core Concept**
The question assesses the understanding of the pathophysiology and clinical consequences of a total gastrectomy, particularly the development of anemia in this patient. Total gastrectomy involves the removal of the stomach, which can lead to malabsorption of essential nutrients, including iron.
**Why the Correct Answer is Right**
The most likely cause of anemia in a patient who has undergone total gastrectomy is iron deficiency anemia. This is due to the malabsorption of iron from the diet, as the stomach plays a crucial role in iron absorption. The acidic environment of the stomach, created by the secretion of hydrochloric acid, is essential for the conversion of non-heme iron into a more soluble form that can be absorbed in the duodenum. Without a stomach, the patient is unable to properly absorb iron, leading to iron deficiency anemia.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not relevant to the context of total gastrectomy and iron deficiency anemia.
**Option B:** While vitamin B12 deficiency can occur after gastric surgery, it is not the most likely cause of anemia in this patient, as the question does not mention any symptoms or signs suggestive of B12 deficiency, such as neurological or hematological abnormalities.
**Option C:** This option is not directly related to the pathophysiology of anemia after total gastrectomy.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that patients who have undergone gastric surgery, including total gastrectomy, are at high risk of developing iron deficiency anemia due to impaired iron absorption. This can be prevented or managed with iron supplements and regular monitoring of iron levels.
**Correct Answer:** C.