Q about: lactose intolerance diarrhea

[cliffh65]

This is an NBME Q, I am so confused

Which of the following is the best explanation for lactose intolerance diarrhea?
A) Impaired intestinal motility
B) Inflammatory process
C) Malabsorption
D) Secretory process

I couldn't find any answer among these choices.
Anyone can help?

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[newguy]

c

 

[SOUNDMAN]

C. Can't break it down, so it goes down intestine where bacteria break it up, and create an osmolar difference, bringing water into intestinal lumen. Gives you diarrhea.

 

[QuinnB]

It's C; people get confused b/c you are eventually going to secrete fluid 2/2 to the osmotic difference but it is a primary disorder related to malabsorption of lactose resulting from a deficiency in lactase; a true secretory diarrhea is not dependent on osmotic difference (i.e. Cholera infx) per se....I think.

 

[cliffh65]

But to my understanding, Malabsorption is the state of impaired absorption of nutrients in the small intestine.
Causes including those diseases involved in fat absorption:
Coeliac disease
Crohn's disease
Insufficiency of the pancreas (e.g. after pancreatitis or in cystic fibrosis)
Whipple's disease

Even in Kaplan-Internal Medicine- p17, I couldn't find a clue for Lactose intolerance as a Malabsorption disease. You don't lose weight from it.

That's why I do not consider Lactose intolerance as a Malabsorption disease.

Please correct me if I was wrong.

 

[Idiopathic]

Definitely malabsorption.

Just because it isnt a classic fat losing enteropathy, it is still a malabsorptive state, in this case being a lactose malabsorption.

 

[cliffh65]

Thanks!
Now I got convinced.

 

[SquidDoc]

C. If I remember correctly, it causes an osmotic diarrhea, not a secretory diarrhea.

 

[Idiopathic]

you are correct

 

[SmallIslandDoc]

This is an NBME Q, I am so confused

Which of the following is the best explanation for lactose intolerance diarrhea?
A) Impaired intestinal motility
B) Inflammatory process
C) Malabsorption
D) Secretory process

I couldn't find any answer among these choices.
Anyone can help?

I believe the answer is "Secretory process". Lactose (a sugar) remains in the bowel, which result is this sugar pulling water with it and causing osmotic diarrhea.

 

[SmallIslandDoc]

I believe the answer is "Secretory process". Lactose (a sugar) remains in the bowel, which result is this sugar pulling water with it and causing osmotic diarrhea.

 

[SOUNDMAN]

Secretory Diarrhea - Caused by abnormal ion transport across the intestinal epithilial cells. This can result in increased secretion or decreased absorbtion. Examples include cholera, e.coli, celiac sprue, etc.

Osmotic Diarrhea - Presence of unabsorbable solute, brings fluid into the lumen. Causes an osmotic gap that is increased. Examples include: Lactose intolerance, malabsorption, poorly absorbed sugars..etc.

So the answer to this question IMHO is clearly C, this is not a secretory process, and I have yet to be convinced otherwise.

http://www.clevelandclinicmeded.com/diseasemanagement/gastro/diarrhea/diarrhea.htm

 

[Idiopathic]

it isnt secretory