Mr. Pope is complaining of headache, a gnawing epigastric pain, and diarrhea. Hi
ID: 3517142 • Letter: M
Question
Mr. Pope is complaining of headache, a gnawing epigastric pain, and diarrhea. His care-provider asks him the following questions:
Have you had these symptoms previously? Response: “Yes but not as bad.”
Are you allergic to any foods? Response: “Shellfish does not like me and milk gives me ‘the runs’.”
His care-provider recommends a lactose-free diet.
1. Why is this diet prescribed? (What differential diagnosis is the doctor working from? How would this diet correct this possible diagnosis?)
Despite the new diet, Mr. Pope’s problems persist. In fact, the symptoms and diarrhea get worse and by the end of the next day, he is in severe abdominal pain. He is asked some more questions to probe his condition. One is whether he has travelled outside the country recently, which he has not, reducing the possibility of Shigella bacteria, which is associated with sanitation conditions.
Do you drink alcohol and how much? Response: “Little or none.”
Have you recently eaten raw eggs or a salad containing raw eggs at a gathering? Response: “No.”
Are there certain foods that seem to precipitate these attacks? Response: “Yes, whenever I have a sandwich.”
2. On the basis of these responses, what other differential diagnoses can be ruled out? Why?
3. What are some possible differential diagnoses that could still be the problem?
4. What would your diagnosis be at this point? What treatment would you prescribe to the patient?
Explanation / Answer
ANSWER:
From the symptomatic point of view Pope care provider thaght that it might be lactose intolerence as he is allergic to milk and its products from childhood.
Because of which she advised him for a lactose free diet.In racially determined lactose deficiency,jejunal morphology is normal .Secondary lactose deficiency occurs at a consequence of disorders which damage thr jejunal mucosa.
for eg.,Coeliac disease and viral gastroenteritis.
Unhydrolysed lactose enters the colon,where bacterial fermentation produces volatile short chain fatty acids , hydrogen and carbondioxide.
Symptoms of LACTOSE INTOLERENCE are:
But the patient symptoms got worse at the end of the next day even with lactose free diet,because according to the given history ,his symptoms started after having a sandwich and he also experienced the same symptoms whenever he eats sandwich but it was not mentioned whether veg or non veg sandwich.
So from the information given by the patient he is allergic to sandwich ,which he should avoid strictly.And this is irritating his bowel ---IRRITABLE BOWEL SYNDROME leading to diarrhoea and epigastric pain.
Food allergies are immune mediated disorders due to IgE Antibodies and type 1 Hypersensitive reaction.
Food allergies are commonly caused due to
As the patient is allergic to shellfish, this might have aggravated his problem as he might have consumed sandwich with shellfish.
TREATMENT:
DIFFERENTIAL DIAGNOSIS:
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