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Enteral vitamin B12 supplementation is effective for improving anemia in patients who underwent total gastrectomy

Monitor closely for hypothalamic amenorrhea, a condition where excessive energy deficit suppresses the hypothalamic-pituitary-gonadal axis

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If symptoms are persistent, severe, or accompanied by red flags (difficulty swallowing, unexplained weight loss beyond tirzepatide effects, vomiting), an endoscopic evaluation may be warranted

A Web of Interconnections The above diagram is still incredibly simplified and omits many further interconnections