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GI #1 > IBS & constipation > Flashcards

IBS & constipation Flashcards

1
Q

criteria for constipation

A

ROME criteria– 2+ is positive
* straining a lot
* lumpy or hard stools
* incomplete evacuation
* anorectal blockage
* manual maneuvers
* under 3 defecations/wk

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2
Q

normal vs slow vs outlet delay severe idiopathic chronic constipation

A
  • normal transit: under 68 hrs is normal or 2.8 day
  • slow: no increase in motor function after meals or to stimulation or over 5 hinton markers
  • outlet delay: normal transit through colon but slows at rectum
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3
Q

which type of constipation suggests anorectal dysfunction and 3 conditions where its seen

A

outlet delay
- mega-rectum/impaction
- hirschsprung dz– no smooth muscle relaxation
- dyssynergic defecation

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4
Q

failure of relaxation or inappropriate contraction causing narrowed anorectal angle & an increase in anal canal pressure; can be conscious or unconscious

A

dyssynergic defecation

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5
Q

abnormal dilation of colon that is not caused by mechanical obstruction

A

Megacolon

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6
Q

6 classes of meds that can cause constipation

A
  • narcotics
  • CCB
  • antidepressants
  • antipsychotics
  • diuretics
  • anticonvulsants
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7
Q

4 neuro disorders & 4 systemic/metabolic disorders associated with constipation

A
  • neuro– MS, parkinsons, stroke, SCI
  • systemic/metabolic– hypothyroid, DM, scleroderma, amyloidosis
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8
Q

5 red flag sx of constipation

A
  • fever, wt loss
  • blood in stool to the point that water is red
  • anemia
  • fam h.o
  • waking up d/t pain or needing poop
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9
Q

diagnostic tool to evaluate for outlet delay? if thats normal whats next?

A

anal rectal manometry. if normal then colonic transit study w/ radiopaque markers

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10
Q

good for kids w/ severe constipation or adults w/ anorectal dysfunction
watch EMG activity and modify responses

A

biofeedback

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11
Q
  • Used for solid immobile stool in rectum
  • manual, mineral oil enema, gastrografin enema
A

disimpaction

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12
Q

when is surgical subtotal colectomy used (2)? when is it not used (1)?

A

severe sx
colonic inertia
NOT for pelvic floor dysfunction

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13
Q
  • absorbs water and increases fecal mass which can lead to increased frequency and softer stools
  • SE: gas, bloating
  • C/I: bowel obstruction
A

bulk forming laxative
(methylcellulose, psyllium, polycarbophil)

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14
Q
  • Lowers surface tension of stool so water can easily enter→ softens stools
  • Often used in combo w/ bulk forming laxatives
  • SE: contact dermatitis, diarrhea, cramping

what is this & what are the 3 CI?

A

docusate sodium
* if concerned for bowel obstruction
* acute abdomen
* appendicitis

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15
Q

Increase intestinal water secretions→ increased stool frequency
* caution– electrolyte distrubaces in renal & cardiac dysfunction
* caution in elderly

A

osmotic agents (polyethylene glycol, Mg citrate, glycerin)

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16
Q

Alters electrolyte transport through intestinal mucosa→ increases intestinal motility
ok for long term
C/I: acute abdomen, GI obstruction/perforation, toxic megacolon
SE: melanosis coli, cramping, low K+ (salt overload)

A

stimulants (senna, bisacodyl)

17
Q
  • Increases intestinal fluid secretion & motility
  • Best for severe constipation when other things failed
  • C/I: severe diarrhea, liver impairment, obstruction
A

lubiprostone

18
Q

Stimulates intestinal fluid secretion & transit; Minimally absorbed peptide agonist of guanylate cyclase-C receptor
* CI: Under 18 y.o; Concern for obstruction
* SE: Diarrhea, Abdominal pain, bloating

A

linaclotide

19
Q

symptoms of abdominal pain or discomfort and associated with disturbed defecation
NO structural abnormalities

A

IBS

20
Q

ROME Criteria for IBS

A

Recurrent abdominal pain or discomfort 1day/wk in last 3 months w/ 2+ of:
1. related to defecation
2. associated w/ change in frequency
3. or form of stool

21
Q
  • Abdominal tenderness
  • Abnormal stool passage – incomplete evacuation or rectal dissatisfaction
  • Passage of mucous
  • Abdominal bloating with distention
  • Sensation of distention
A
22
Q
  • Sexual dysfunction
  • Dysmenorrhea
  • Increased urination
  • Body aches and pains
A

extraintestinal sx of IBS

23
Q

4 types of IBS

A
  1. IBS-D
  2. IBS-C
  3. IBS-M
  4. IBS-unclassified
24
Q

3 tests for IBS

A

CBC
stool hemoccult
colonscopy if patient is over 50

25
Q

if sx warrant, what are 5 tests you could do

A
  • serum chemistries
  • albumin
  • stool ova and parasites, Giardia
  • TTG IgA and serum IgA
  • Fecal calprotectin or fecal lactoferrin
26
Q

3 elements of IBS pathophys

A

hypersensitivity, altered gut activity, dysregulation

27
Q

risk for post-infectious IBS (9)

A
  1. young female
  2. smoker
  3. Prolonged fever
  4. Severe diarrheal illness
  5. Weight loss of ≥ 10 lbs. during diarrheal illness
  6. Bloody diarrhea
  7. Pre-existing anxiety or depression, History of stress
  8. antibiotics hx
  9. Sleep disturbance
28
Q

psychosocial factors that affect IBS

A

abuse, stressful life events

29
Q

dietary tx of IBS

A

LOW FODMAPS for 2 wks
gluten reduction/avoidance for 4-6 wks (avoid wheat, barley and rye)

30
Q
  • anticholinergic properties causing selective inhibition of GI smooth muscle which reduces the intestinal motility and spasm
  • best if used intermittently to reduce pain and bloating
  • caution in elderly, CHF, CAD, renal/hepatic impairment, risk of obstruction, glaucoma

what is this? what are some SE (5)

A

antispasmodic agents (dicyclomine and hyoscyamine)
SE: xerostomia, dry eye, UA retention, constipation, sleepiness

31
Q

great for global IBS sx
caution w/ abrupt withdrawl, eldely, pregnant, DM, etc
SE: Na, HA, insomnia, nervousness, anxiety, drowsiness

A

antidepressants (TCA or SSRI)

32
Q

Slow stool transit time and frequency by binding gut wall opioid receptors and inhibiting peristalsis
- no effect on discomfort or pain
C/I: no diarrhea, bloody diarrhea, UC, under 2, pseudomembranous colitis
SE: cramping, nausea, dizziness, etc

A

loperamide & lomotil (antidiarrheal agents)

33
Q

antibiotic for IBS-D NOT for C. diff, child-pugh, possible fetal harm

what is it? SE?

A

Rifaximin
SE: nausea, elevated ALT

34
Q

4 other tx for IBS

A
  • probiotics (caution in diverticulitis, ulcer, perforation)
  • peppermint oil capsules (Ibguard)
  • fecal microbiota transplant (inconclusive)
  • lifestyle– less smokng, sugar substitutes, birthcontrol for periods, aerophagia
35
Q

how does abdominal pain from IBS typically present

A

cramping, diffuse and relieved by bowel movement

36
Q

describe IBS diarrhea

A

watery, NOT bloody

bloody would be in UC

GI #1 (10 decks)

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