|
Lactose Intolerance
 | Presentation
 | Intermittent, crampy diarrhea of significant duration |
|
| History
| Diarrhea at night? |
| Associated symptoms: flatulence, bloating, cramps,
PUD, GERD |
| Recent changes in diet or meds |
| Number of stools/day? Color? Consistency?
Smell? |
| Blood? Fat droplets? Undigested food? |
| Sexual history |
| Travel history |
| Family history of colon CA, IBS |
|
| PE
| Vitals: orthostatics |
| Quick heart and lung exam |
| Abdominal exam |
| Rectal exam |
|
| DDx
| Osmotic (lactase deficiency) |
| Bacterial/viral gastroenteritis, parasites |
| Colon CA, IBD, IBS |
| Pancreatic insufficiency, CF |
| Celiac disease, Whipple's disease |
| Villous adenoma |
|
| Laboratory
| Stools x 3 for hemoccult, fat, WBCs, pH, O and P |
| CBC w/ diff, BMP, amylase, lipase |
| Test for lactose intolerance (give known amt of lactose,
see how much blood glucose rises) |
| Colonoscopy if refractory to treatment |
|
| Treatment
| Avoid dairy, use lactaid. |
| Increase dietary fiber. |
| Calcium and Vit. D supplements. |
|
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