NBME 6 question HELP - interferon_advocate

[ArchivalUser]

A 62-year-old woman comes to the physician because of bloating and cramping abdominal pain and intermittent diarrhea over the past 5 years. Her symptoms have increased over the past month since she started a new diet that emphasizes yogurt and cottage cheese as low-fat sources of calcium and protein. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound tenderness; there are no masses or organomegaly. Bowel sounds are increased. Test of the stool for occult blood is negative. Which of the following is the best explanation for this patient's diarrhea?

A) Impaired intestinal motility
B) Inflammatory process
C) Malabsorption
D) Secretory process

this question is driving me CRAZY, please someone help that got this question correct on the nbme6
it sounds like IBS, and MEETS the criteria for IBS (rome criteria) so maybe answer is B?

@letitgo you mentioned it was malabsorption, did you get this correct on nbme? it cannot be malabsorption in my opinion cause malabsorption leads to steatorrhea + vitamin deficiencies and with that long condition they would be flaring up all the deficiencies... please correct if Im wrong

please someone explain this question, thanks

[ArchivalUser]

could it be small bowel bacterial overgrowth, so the intake of probiotics made the diarrhea worse?
so answer is C?

please I just need someone that had a correct answer to work from that point on,
guys really please help. =(

[ArchivalUser]

I Think C.. elderly patient with chronic diarrhea and worsening of symptoms with dairy products is common in lactase deficiency..

[ArchivalUser]

yeap i agree its C... lactase deficiency

[ArchivalUser]

thanks guys for replying! do you know for sure if this is the right answer?

wouldnt lactase deficiency give secretory diarrhea instead?
please kindly explain more your answers thanks

[ArchivalUser]

Lactase deficiency: Lack of the enzyme lactase in the small intestine.
Lactase is needed to digest lactose, a sugar found in milk and most other dairy products and also used as an ingredient in other foods. Although most people are born with the ability to make adequate amounts of lactase, the production of lactase normally decreases with age, and there are significant differences in lactase production among ethnic groups. People of African or Asian descent commonly have difficulty digesting products that contain lactose. The most common symptoms of lactase deficiency are diarrhea, bloating, and gas. Treatment usually involves avoiding lactose in the diet or taking over-the-counter lactase supplements before eating foods that contain lactose.

[ArchivalUser]

Secretory diarrhea is usually due to bacterial toxins such as staph/ecoli/vibrio or due to hormones such as vip/gastrin/calcitonin so this is not the case in this question. According to the question she had some symptoms before which worsened with her new diet so it seems more like lactose intolerance, I agree with other guys. This is not inflammatory either. lactose intolerance gives osmotic diarrhea and malabsorption.

[ArchivalUser]

finally I understand,
thanks so much avice and izaldivar, wow you guys made it very clear!!!
God bless thanks again for helping out

[ArchivalUser]

Made some research about this to further review and Id like to share

Malabsorptive diarrhea is characterized by excess gas, steatorrhea, or weight loss.

CHRONIC DIARRHEA is further divided into: Watery, Fatty, Inflammatory

Watery can be subdivided in: osmotic, secretory and functional.

SECRETORY---> bowel secretes too much fluid, VERY HIGH volume stools, caused by enterotoxins, bile acids(when ileal resection), carcinoid sx, VIPoma.

OSMOTIC---> non absorbable solutes that stay in bowel and drag water in, its SMALLER volume stools.
lactose intolerance and celiac disease

FUNCTIONAL---> IBS, where hallmark is hypermotility, has smaller volumens and symptoms disappear at night.

SOME IMP FACTS to differentiate between osmotic and secretory:

(1) Stool osmolality: more than 50 in Osmotic diarrhea and less than 50 in secretory diarrhea

(2) On fasting: Diarrhea stops in Osmotic diarrhea

(3) Stool volume: more than 1L in secretory, less than 1L in osmotic