A 56-year-old man visits the emergency room after experiencing significant sudden widespread stomach discomfort. Epigastric pain that the patient has been dealing with for three months has responded to treatment with proton-pump inhibitors. A stiff abdomen with rebound tenderness is apparent on physical examination. Abdominal radiographs reveal free air under the diaphragm. Therapy for support is started. A massive, perforated stomach ulcer with characteristics indicative of malignancy is discovered during an exploratory laparotomy. He undergoes partial gastrectomy with gastrojejunostomy. Long-term supplementation with which of the following is most important in this patient?

Question

A 56-year-old man visits the emergency room after experiencing significant sudden widespread stomach discomfort. Epigastric pain that the patient has been dealing with for three months has responded to treatment with proton-pump inhibitors. A stiff abdomen with rebound tenderness is apparent on physical examination. Abdominal radiographs reveal free air under the diaphragm. Therapy for support is started. A massive, perforated stomach ulcer with characteristics indicative of malignancy is discovered during an exploratory laparotomy.   He undergoes partial gastrectomy with gastrojejunostomy.  Long-term supplementation with which of the following is most important in this patient?

Quizplus · Accepted Answer

Eductional Objective: Iron deficiency anemia is caused by bypassing the duodenum and proximal jejunum, two parts of the small intestine where iron absorption occurs primarily. The post-surgical drop in stomach acidity also reduces iron absorption and could be a factor in these patients' iron deficit. Pharmacologic iron supplementation is used as treatment, enabling adequate iron absorption at secondary absorption sites in the distal small bowel.
Following gastrojejunostomy, deficiency in thiamine, folate, vitamin B12, fat-soluble vitamins (particularly vitamin D), and calcium is also typical.

A 56-Year-Old Man Visits the Emergency Room After Experiencing Significant