CASE STUDY NO.

2
By Block1-GROUP 6

A young female adult

(20 years old med
student), complains of
intestinal problems. The
symptoms of bloating gas,
cramps, and explosive
diarrhea present shortly
after drinking milk or
consuming certain dairy
products and foods

1. What is most likely the

diagnosis?
LACTOSE INTOLERANCE
>is

the inability or insufficient

ability to digest lactose, a sugar
found in milk which results in
gastrointestinal issues about 30
minutes to two hours after
consuming dairy products.

1. What is most likely the

diagnosis?
CAUSE OF LACTOSE INTOLERANCE
>An

enzyme called lactase is

needed by the body to digest
lactose. When the small intestine
does not make enough of this
enzyme, lactose intolerance
develops.

Lactose Intolerance
Types
1. Inherited forms
These are passed on through families:
a. Primary lactase deficiency: this
causes low levels of lactase. Symptoms
can develop at any age but rarely
before the age of 6.
b.Congenital lactase deficiency: this
causes a complete lack of lactase from
birth. Symptoms develop as soon as the
baby is given milk or lactose formula.

Lactose Intolerance
Types
2. Secondary lactase deficiency
> arises when an infection or disease

including celiac disease,

infectious enteritis, or Crohns
disease---- damage the small
intestine.
> Treating the underlying issue
usually reverses
the lactose intolerance.

Lactose Intolerance
Types
3. Developmental lactase
deficiency
> When a baby is born, it takes time for

a
reasonable amount of lactase to build up in
the digestive system. Babies more than
six weeks
premature may be born with
very low levels of
lactase, leading to
temporary lactose
intolerance.
The
condition disappears as the baby gets
older.

2. What can the

diagnosis be
confirmed?
ELIMINATION DIET

Removing lactose containing food

products from the diet for 14
days.Any relief of symptoms during
the diet period points towards an
intolerance to lactose. This can be
confirmed if symptoms return when
lactose is re-introduced into the diet.

2. What can the

diagnosis be
confirmed?
TESTS

NORMAL
RESULTS

HYDROGEN involves measuring increase in

the amount of a
hydrogen is less
BREATH
gas called
than 12 parts
TEST
hydrogen in your
breath after taking
a test dose of
lactose.
looks for glucose
LACTOSE
TOLERANCE in the blood. The
body creates

BLOOD

per million over

your fasting (pretest) level.
glucose

level
rises more than
30 mg/dL within

3. What brought about

the diarrhea in the case?
What is the mechanism
involved?
In normal digestion, lactose is digested in

the small intestine without the release of

gas bubbles. When lactose can't be
digested well, it passes into the colon.
Bacteria in the colon break down some of
the lactose, producing hydrogen gas. The
remaining lactose also draws water into
the colon. The extra gas and water result
in symptoms, such as cramping,

PATHOPHYSIOLOGY

4. How is the disorder

treated?
The best way to manage lactose intolerance is to
maintain a lactose-free diet or keep a periodic
consumption of lactose below the 12-gram limit.
Lactose-Containing Foods:
Ice cream
Sherbet
Yogurt
Butter
Heavy, light, whipping, and sour creams
Whey
Cheese

4. How is the disorder

treated?
In addition to milk-based products,
many processed foods have lactose
added to them, according to the Food
and Drug Administration (FDA).

These sometimes
include:
Non-kosher lunch meats
"Instant" products, such
as soups
and potatoes
Powdered meal
replacements
Cereals

Baked goods
Breads
Dressings and creamy
sauces
Frozen dinners
Snack food, including
candy
Margarine

NOTE!
Avoiding all dairy products can mean you
don't get enough calcium. Calcium is a
mineral needed for bones to grow normally
and be strong. Lack of it could mean children
don't grow as well as they should, or adults
could have weak bones that break easily.

SO,
make sure to supplement the diet with foods
enriched with calcium and Vit. D if you're on a
lactose free-diet.

"lactose-free" products that

are sources of calcium
and/or vitamin D:
Soy, almond, rice,
and
coconut milk
Sardines
Salmon
Collard greens
Kale
Almonds

Broccoli
Spinach
Fatty fish (tuna,
mackerel, and
salmon)
Fish liver oil
Calcium-fortified
orange juice

Other Lactose Intolerance

Treatments:
Dietary supplements containing lactase
Drink hydrolyzed milk, or lactose-reduced

milk, (by adding lactase to the milk hours

before consuming it.)
Ingestingprobiotics(beneficial bacteria)
Eating yogurt containing live bacteria
Incrementally adding more lactose to
diet

THANK
YOU!

3. How is the disorder be

treated?
Primary lactose intolerance
give milk or dairy products little and often
have milk with meals
Full-fat or chocolate milk may be better
than skimmed milk
Thicker foods such as yoghurts and curds
are likely to be
better tolerated because they move
through the bowel at a
slower rate.
Live yoghurts and hard cheese may not
cause problems

3. How is the disorder be

treated?
Secondary lactose intolerance
Due to damage to the lining of the gut
(small intestine), may need treatment by:
fluid through a drip if the diarrhea is very
severe
if the diarrhea is very prolonged, or in
very
young babies, withdraw lactose for three
weeks after the
infection.
breast milk, formula milk or cow's milk for
babies and

3. How is the disorder be

treated?
Developmental lactase
deficiency
The chance of premature babies getting
lactose intolerance
due to developmental lactase deficiency
can be reduced by
feeding them half-strength lactose
formula or breast milk.

Sources:
http://www.everydayhealth.com/lactoseintolerance/treatment/
Wilt et al. (2010). Lactose Intolerance and Health.
AHQR Evidence Reports.
Mattar et al. (2012). Lactose Intolerance: Diagnosis,
Genetic, and Clinical Factors.
Clinical and Experimental Gastroenterology.
Montalto et al. (2006). Management and Treatment of
Lactose Malabsorption.World Journal of Gastroenterology.
Problems Digesting Dairy Products?;FDA.
Lactose Intolerance;
National Institute of Diabetes and Digestive and Kidney Di
seases
.
http://patient.info/health/lactose-intolerance-leaflet