Integrative clinical judgement: A patient with short bowel (50% small intestine removed) presents months later with steatorrhea and anemia. Which combination of pathophysiologic explanations best evaluates the primary causes of these findings?

Removal of half the small intestine increases bile production which directly destroys enterocytes causing anemia, while fat absorption increases and steatorrhea is unlikely; therefore blood transfusion is the only treatment

The colon takes over all small intestinal functions immediately so steatorrhea and anemia indicate a primary hepatic failure unrelated to bowel resection

Short bowel leads to decreased gastric acid secretion which prevents pepsin activation in the colon causing protein maldigestion only, leading to isolated hypoalbuminemia without steatorrhea

Reduced absorptive surface area results in decreased uptake of fat and fat-soluble vitamins causing steatorrhea and vitamin deficiencies; decreased iron and B12 absorption sites and faster or disrupted transit can also cause anemia—replacement of nutrients and promoting intestinal adaptation are needed