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7/27/2019 lactose intolerance grp 7 E-1.ppt
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LACTOSEINTOLERANCE
Section E-1 Group 7
SOLIS, Ianne RobinSONACO, Angela Baye B.
SUAREZ, Jaennes S.SUAYBAGUIO, Carl Angelo M.
SUING, Essel Marie L.
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Outline
Case Introduction
Definition of Lactose Intolerance and Lactase
Food Sources of Lactose
Normal Digestion and Utilization of Lactose
Definition and Differentiation of Lactoseand Lactase Deficiency
Distinct Clinical Syndromes of Lactase Deficiency
Characteristic Clinical Manifestations
of Lactose Intolerance
Laboratory Tests/Proceduresto Diagnose Lactose Intolerance
Therapy & Treatment for Lactose Intolerance
Case Discussion and Application
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Case Introduction
SALIENT FEATURES54 y/o, female Chief complaint:
Abdominal distension & bloating after meals Associated w/:
flatulenceEpisodic diarrhea (30mins-4hours after meals)Mild suprapubic cramping & urgency before BM relieved by defecating
(-) Nausea/Vomiting(-) Skin rash Past Medical History:
(-) DM(-) Prev GI surgery(-) History of foreign travel(-) Radiation exposure(+) Osteoporosis-15months ago
-
dietary calcium intake(3cups of milk/day) Physical examination:
-Unremarkable Stool examination:
- (-) for occult blood Flexible sigmoidoscopy
- normal
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Lab Tests:
Hemoglobin = 15 g/dL (normal = 14-16 g/dL)Hematocrit = 46% (normal = 44-50%)
Serum albumin = 4.5 g/dL (normal = 3.8-4.8g/dL)
Serum cholesterol = 210 mg/dL (normal =
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Lactose
Lactose (galactosyl-P- 1,4-glucose)in the milk of mammals (including humans)is the major dietary source of galactose.Lactose is hydrolyzed in the intestine bylactase. Galactose produced by hydrolysisof dietary lactose is mostly in the form of
the alpha-isomer.
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Lactase
Lactase is the enzyme needed todigest Lactose in the intestine, with the
absence of Lactase, the Lactose cannotbe digested and absorb in the body. Andif Lactose cant be digested LactoseIntolerance could happen to a person
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Food Sources of Lactose
Milk, Milk Products bread and other baked goods waffles, pancakes, biscuits, cookies, and mixes to
make them
processed breakfast foods such as doughnuts,frozen waffles and pancakes, toaster pastries, andsweet rolls
processed breakfast cereals potato chips, corn chips, and other processed
snacks margarine salad dressings
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Digestion of Lactose
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Lactose
Stomach
Small Intestines
(Brush border of Proximal Jejunum)
Beta-Glycosidase Complex
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Beta-Glycosidase Complex
Lactase Glucosyl Ceramidase
Split Glucose
and
Galactose from Ceramides
Cleaves via Beta 1,4 Glycosidic bond
Lactose to Glucose and Galactose
Active Secondary Simporter
Glucose and Galacose + SGLT1
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Absorption in the intestinal epithelium
Glucose and Galactose + GLUT 2
Exit to the blood capillaries
GLUT5
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Once broken down into the simple form of sugars, they are now
readily adsorbed. Gluco se and galactose are taken into theenterocyte by cotranspor t wi th sod ium using the same
transporter .
Lactase has two activities. It hydrolyzes phlorizin, a
disaccharide found in roots and bark of plants of the family
Rosaceae and some seaweeds andit also hydrolyzes -
galactoside or pu t simp ly, lactose.
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Lactase hydrolyses (binds water chemically H2O) the linkage. Once
lactose is hydrolysed by the interaction of the lactase enzyme, theenzyme then moves onto the next lactose molecule and does the
same each time.
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The result of the hydrolysed lactose disaccharide is the formation
of glucose and galactose as seen in the image above. These
monosaccharides are readily adsorbed by the transport
mechanism of the enterocytes in the small intestine.
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Transport Mechanism
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Lactose Intolerance
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Lactose
Stomach(Small Intestine)
Absence of Glycosidase Complex
Goes down to large intestine
Normal flora ferment the lactose to lactate
Producing gases and flatulence Attracts water to large intestine
causing osmotic Diarrhea and
bloating
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Differences of Lactose Intoleranceand Lactase Deficiency
Lactose IntoleranceIs usually a disease of adults and is
most often associated with an inadequateamount of an enzyme lactase in the small
intestines, which is essential to digestlactose. Without enough lactase, there islactose intolerance
Lactase DeficiencyNot enough of an enzyme calledlactase in the small intestine to digestlactose
http://www.medterms.com/script/main/art.asp?articlekey=7809http://www.medterms.com/script/main/art.asp?articlekey=7809http://www.medterms.com/script/main/art.asp?articlekey=6200http://www.medterms.com/script/main/art.asp?articlekey=5512http://www.medterms.com/script/main/art.asp?articlekey=5512http://www.medterms.com/script/main/art.asp?articlekey=3266http://www.medterms.com/script/main/art.asp?articlekey=6200http://www.medterms.com/script/main/art.asp?articlekey=5512http://www.medterms.com/script/main/art.asp?articlekey=5512http://www.medterms.com/script/main/art.asp?articlekey=6200http://www.medterms.com/script/main/art.asp?articlekey=3266http://www.medterms.com/script/main/art.asp?articlekey=78097/27/2019 lactose intolerance grp 7 E-1.ppt
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Lactoferrin
also known as lactotransferrin
Found in milk, saliva, tears, and nasalsecretion
Human Colostrum has the highestconcentration
Component of Immune system(antimicrobial)
Provide antibacterial activity to infant
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3 Distinct Clinical Syndromes of LactaseDeficiency:
Congenital Very rare inborn error of metabolism Autosomal recessive pattern Alactasia
Primary, adult lactase deficiency or hypolactasia Most common type Begins to fall after weaning Almost completely lost by late adolescence
Also called Late Onset Lactase DeficiencyOther type is Developmental Lactase Deficiency
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Secondary
Disease or damage to the small intestine villous structure orits function e.g.Celiac disease, Cystic Fibrosis, Short gut syndrome (smallbowel resection), Parasitic infection, - Gardia, Zollinger EllisonSyndrome, Whipples disease
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Clinical Manifestations of Lactose Intolerance:
Meteorism Borborygmi Flatulence Abdominal pain/Colicky pains Dyspepsia Bloating/Fullness
Nausea Diarrhea
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Diagnostic Tests
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Breath Hydrogen Test
After an overnight fast, patient exhales through a breathanalyzer
Water solution of 50 grams of lactose (32 oz of milk) is
then ingested
End-expiratory samples are taken at 30-minute intervalsand compared with zero-time level
Hydrogen breath >20 ppm above zero-time levelHypolactasia
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Oral Lactose Tolerance Test
Ethanol (300 mg/kg) is administered 15 minutes beforeoral lactose
40 minutes after lactose ingestion, blood sample istaken
Blood galactose level of
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Lactose-Ethanol Load TestIngestion of 50g lactose
Serum glucose is measured in fasting state, then every30 minutes thereafter 2 hours following lactose
ingestion
Blood glucose rise of less than 1.1 mmol/L (20mg/dL)
Hypolactasia
Blood glucose rise greater than 1.7 mmol/L (30 mg/dL) lactose persistence
Blood glucose incremental rise of 1.1 - 1.7 mmol/L
inconclusive
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Quantitation of Small Bowel
Lactase Activity
Tissue sample obtained from distalduodenum by endoscopy or jejuna biopsy
Most accurate, but also most invasivemethod
Seldom used clinically to make thediagnosis of lactase deficiency
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Therapy
Amount of lactose that can be tolerated
variesfrom person to persons
Complete lactose restriction to confirm all
symptoms are indeed related to the LactoseIntolerance
Dietary management
Avoiding lactose-containing products
Alternative products
Lactase supplementation
Division into several meal
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Treatment of lactose intolerance should not be aimed at reducing
malabsorption but rather at improving digestive symptoms. Reduction
of lactose intake rather than exclusion is recommended because
long-term effects of lactose restriction may help improvegastrointestinal complaints but can lead to other damages.
Long-term effects of a diet free of dairy products may be a concern as
you are significantly decreasing the amount of calcium. Low calcium
levels are leading to an increase in fractures and orthopaedic
problems.
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Age groupAmount of calcium to consume daily, Age
group in milligrams (mg)
06 months 210 mg
712 months 270 mg
13 years 500 mg
48 years 800 mg
9
18 years 1,300 mg
1950 years 1,000 mg
5170+ years 1,200 mg
Recommended calcium intake by age groupSource: Adapted from Dietary Reference Intakes, 2004, Institute of Medicine, National Academy of Sciences.
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To help in planning a high-calcium and low-lactose diet, the table that
follows lists some common foods that are good sources of dietary calcium
and shows how much lactose they contain.
Vegetables Calcium Content Lactose Content
Calcium-fortified orange
juice, 1 cup308-344 mg 0
Sardines, with edible
bones,
270 mg 0
3 oz.
Salmon, canned, with
edible bones, 3 oz.205 mg 0
Soymilk, fortified, 1 cup 200 mg 0
Broccoli (raw), 1 cup 90 mg 0
Orange, 1 medium 50 mg 0
Pinto beans, 1/2 cup 40 mg 0
Tuna, canned, 3 oz. 10 mg 0
Lettuce greens, 1/2 cup 10 mg 0
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Recent research shows that yogurt with active cultures may be a good
source of calcium for many people with lactose intolerance, even
though it is fairly high in lactose. Evidence shows that the bacterialcultures used to make yogurt produce some of the lactase enzyme
required for proper digestion.
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SUMMARY
Lactose intolerance is the inability or insufficient ability to digest
lactose, a sugar found in milk and milk products.
Lactose intolerance is caused by a deficiency of the enzymelactase, which is produced by the cells lining the small intestine.
Not all people with lactase deficiency have digestive symptoms,
but those who do may have lactose intolerance.
Most people with lactose intolerance can tolerate some amount of
lactose in their diet.
People with lactose intolerance may feel uncomfortable afterconsuming milk and milk products. Symptoms can include
abdominal pain, abdominal bloating, gas, diarrhea, and nausea.
The symptoms of lactose intolerance can be managed with dietary
changes.
Getting enough calcium and vitamin D is a concern for people with
lactose intolerance when the intake of milk and milk products islimited. Many foods can provide the calcium and other nutrients
the body needs.
Milk and milk products are often added to processed foods.
Checking the ingredients on food labels is helpful in finding
possible sources of lactose in food products.
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SALIENT FEATURES54 y/o, female Chief complaint:
Abdominal distension & bloating after meals
Associated w/: flatulenceEpisodic diarrhea (30mins-4hours after meals)Mild suprapubic cramping & urgency before BM relieved by defecating
(-) Nausea/Vomiting(-) Skin rash
Past Medical History:(-) DM(-) Prev GI surgery(-) History of foreign travel(-) Radiation exposure(+) Osteoporosis-15months ago
- dietary calcium intake(3cups of milk/day)
Physical examination:-Unremarkable
Stool examination:- (-) for occult blood
Flexible sigmoidoscopy-
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Lab Tests:
Hemoglobin = 15 g/dL (normal = 14-16 d/dL)
Hematocrit = 46% (normal = 44-50%)
Serum albumin = 4.5 g/dL (normal = 3.8-4.8g/dL)
Serum cholesterol = 210 mg/dL (normal =
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Sources:
Laboratory Manual and Conference GuideLecture Guide in Biochemistry, vol. 1Harpers Illustrated Biochemistry 28th edBiochemistry 5th ed, StryerBiochemistry 4th ed, LehningerLippincott Biochemistry 3rd edMedical Biochemistry: Human Metabolism in Health and Disease, 2009