A person who had undergone gastrojejunostomy suddenly develops severe diarrhoea. Which should be suspected –
**Core Concept**
The patient's symptoms are likely due to an excessive loss of bile salts, which are essential for fat absorption in the small intestine. Bile salts are produced by the liver and stored in the gallbladder, but after a gastrojejunostomy, the bile duct is bypassed, leading to a deficiency of bile salts in the small intestine.
**Why the Correct Answer is Right**
The patient's symptoms of severe diarrhea are likely due to a condition known as **bile salt malabsorption**. Normally, bile salts are reabsorbed in the terminal ileum, but after a gastrojejunostomy, this reabsorption is impaired. The lack of bile salts leads to an increase in the concentration of free fatty acids and monoglycerides in the small intestine, which is not suitable for absorption. This results in **steatorrhea**, a condition characterized by excessive fat in the stool.
**Why Each Wrong Option is Incorrect**
**Option A:** Steatorrhea can be caused by other conditions such as pancreatic insufficiency, but it is not the most likely cause in this scenario.
**Option B:** Lactose intolerance is a condition where the body is unable to digest lactose, a sugar found in milk, but it is not related to bile salt malabsorption.
**Option C:** Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, but it does not typically present with steatorrhea.
**Option D:** Celiac disease is an autoimmune disorder that causes the small intestine to react to gluten, leading to malabsorption, but it is not directly related to bile salt malabsorption.
**Clinical Pearl / High-Yield Fact**
After a gastrojejunostomy, patients are at risk of developing bile salt malabsorption, which can lead to steatorrhea and malnutrition. It is essential to monitor these patients for signs of malabsorption and consider supplements or dietary modifications.
**Correct Answer: C. Irritable bowel syndrome (IBS)**