Malabsorption syndromes Quiz: Ace Your Exams
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A 29-year-old woman comes to the physician complaining of recurrent bloating and diarrhea over the past 2 months. She has bulky and foul-smelling diarrhea that is often difficult to flush. The patient had a Roux-en-Y reconstruction 5 years ago for morbid obesity that was refractory to diet and lifestyle modifications. Since then, she has lost 45-lbs, which has significantly improved her daily life. Physical examination reveals conjunctival pallor. Laboratory studies demonstrate a hemoglobin of 10.3 g/dL and mean corpuscular volume (MCV) of 101 µm3. Serum electrolytes are normal. Stool analysis shows no occult blood and stool culture is negative. The patient is asked to ingest 25 g of D-xylose following an overnight fast. Urine concentration of D-xylose after several hours is 3.0 g (normal ≥4.5 g). The physician prescribes her oral antibiotics, and the test is repeated after 2 weeks. Subsequent urine concentration is 9.2 g. Which of the following is the most likely cause of this patient’s symptoms?
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