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2. In the case study below you will explore the causesof B12 deficiency in three patients.

A. Patient A is a college student who has becomeincreasingly tired over the last six months. She thought it wasbecause of her tough schedule but since she noticed tingling in herfeet, she thought she should see a doctor. Patient A also hashyperparathyroidism, an autoimmune disorder that affects 100,000people in the U.S. every year. She is not a vegetarian and eatsmilk, eggs and meat - all great sources of B12. The doctor ran someblood work and found very low levels of B12. The patient also hadparietal cell antibodies present in her blood.

• What do you think is the cause of her B12 deficiency?Why is her body not able to absorb the necessary B12?

• What is the treatment and prognosis for thispatient?

• B. **** Patient B had gastric bypasssurgery three years ago. He is a vegetarian and sees a nutritionistwho ensures his diet is adequate to meet his nutritional needs.Despite this, on a recent trip to his doctor, his blood work showeddeclining levels of vitamin B12.

• Why does this patient have low B12 even though his dietshould be providing enough?

• Why didn’t Patient B have low B12 until three yearsafter surgery?

• C. **** Patient C suffers from Crohn’s disease and had a60 cm terminal ileal resection 4 months ago.

• What is a terminal ileal resection?

• What is Crohn’s disease and what complication led to theneed for an ileal resection?

• What is absorbed by the ileum?

• Will amino acid and glucose uptake be affected by theileal resection? Explain.

• What is the treatment and prognosis for this patient toensure she receives necessary nutrition?