In biliary obstruction, which vitamin deficiency will be seen: March 2012
So, in biliary obstruction, you'd expect deficiencies in all of A, D, E, K. But the options here might not have all four. Wait, the correct answer here is probably vitamin K because it's the one most commonly associated with bleeding issues, which is a classic sign. But the question is asking which deficiency will be seen. Since all fat-soluble vitamins are affected, but maybe the options are different. Wait, the original question's options are A to D but the user didn't provide them. Wait, the user's correct answer is missing. Let me check the original message again.
Wait, the user provided the correct answer as C. But the options aren't listed. So maybe in the original question, the options were A to D with vitamin K as option C. Let me think. The key point is that biliary obstruction leads to fat-soluble vitamin deficiency. So if the options included vitamin K, that's the answer. But if the options included other vitamins, like maybe B12 or C, those are water-soluble and not affected. So the correct answer is vitamin K deficiency because it's fat-soluble and requires bile for absorption. The explanation should highlight that biliary obstruction impairs absorption of fat-soluble vitamins, leading to deficiencies, with vitamin K being crucial for blood clotting, so deficiency causes coagulopathy.
**Core Concept**
Biliary obstruction impairs absorption of fat-soluble vitamins (A, D, E, K) due to disrupted emulsification of dietary fats. Vitamin K deficiency is most clinically significant because it disrupts gamma-carboxylation of clotting factors, leading to coagulopathy.
**Why the Correct Answer is Right**
Vitamin K is a fat-soluble vitamin absorbed in the small intestine via micelle formation, which requires bile salts. In biliary obstruction (e.g., gallstones, cholangiocarcinoma), bile flow is blocked, preventing micelle formation. This leads to vitamin K deficiency, reduced synthesis of clotting factors II, VII, IX, X, and increased INR (prolonged prothrombin time). Patients may present with bleeding diathesis or bruising.
**Why Each Wrong Option is Incorrect**
**Option A:** Vitamin B12 deficiency is unrelated to biliary obstruction. B12 is absorbed via intrinsic factor in the terminal ileum, not dependent on bile.
**Option B:** Vitamin C is water-soluble; deficiencies occur in malnutrition, not biliary disease.
**Option D:** Folic acid (B9) is also water-soluble and unaffected by biliary obstruction.
**Clinical Pearl / High-Yield Fact**
Remember the **FATTY** acronym for fat-soluble vitamins: **A, D, E, K**. In obstructive jaundice, vitamin K deficiency is the most clinically urgent due to its role in coagulation. Administering parent