fatboyslimAlso, for those who are wondering, there is an absence of the ankle jerk reflex because B12 deficiency causes peripheral neuropathy as well. Peripheral neuropathy affects the longest nerves first, this explains why there is no reflex in the ankle while there is hyperreflexia in the arms and knees (which are UMN signs d/t lateral corticospinal tract involvement)+
submitted by โcassdawg(1780)
Total gastrectomy = absence of parietal cells
Parietal cells are necessary to secrete intrinsic factor which binds vitamin B12 to allow absorption.
Also his symptoms (which fit the description of subacute combined degeneration) are characteristic of B12 deficiency.
FA2020 p69 (insert sunglasses emoji here)