Vitamin K deficiency vs. ITP

[Northerncardinal]

A uworld question about a pt with crohn`s disease presenting with easy bruising. He had partial bowel resection a year ago. He has been experiencing generalized fatigue, poor apetite, and dull pain and stiffness in his lower back and joints at night. 3 months ago he was treated with oral antibiotics for a perianal fistula. Physical exam shows large ecchymoses on his lower extremities. what`s the likely diagnosis?

A. Autoimmune hepatitis
B. Bile acid malabsorption
C. Factor 8 deficiency
D. ITP
E. Leukocytoclastic vasculitis

The data showed that majority of the students chose B and D. I also chose D. (ITP).

I was wondering why is it not D??

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[Charleybacktoreality]

Probably due to history of partial resection, Crohn's loves to involve temrinal ileum, which was resected, that's where bile acids are reabsorbed mainly, while ITP would have other symptoms too like CNS,Renal failure+ they would give us platelet count, PT and stuff, biggest clue was probably crohn's and rejection but that's just me

 

[Charleybacktoreality]

why it is not B?

 

[AZ7]

A uworld question about a pt with crohn`s disease presenting with easy bruising. He had partial bowel resection a year ago. He has been experiencing generalized fatigue, poor apetite, and dull pain and stiffness in his lower back and joints at night. 3 months ago he was treated with oral antibiotics for a perianal fistula. Physical exam shows large ecchymoses on his lower extremities. what`s the likely diagnosis?

A. Autoimmune hepatitis
B. Bile acid malabsorption
C. Factor 8 deficiency
D. ITP
E. Leukocytoclastic vasculitis

The data showed that majority of the students chose B and D. I also chose D. (ITP).

I was wondering why is it not D??

Bile acid malabsorption causing inability to absorb fat soluble vitamins hinted at primarily with the Chrons disease mention.
Note the history of antibiotics. Hinting at disturbed gut flora. ( Also Recall that most Vit K is not from the diet, but rather produced by microbiota. )
ITP usually also has a previous history of viral infection (Flu-like illness) that can act as an environmental trigger.