Functional bowel disorder

Question 1

Functional dyspepsia
def
age and gender involvement
Syndromes with SS
investigation

Answer 1

dyspepsia with no organic cause
young and women
syndromes:
post prandial distress= bloat, retching, early satiety, loss of appetite, nausea and vomiting
epigastric pain syndrome= epigastric pain or burning

investigation
h. pylori test
endoscopy if alarm feature
US

Question 2

Rx of Functional dyspepsia?

Answer 2

postprandial distress
pro-kinetic drugs= metoclopromide
fundus relaxing drugs= buspirone
centrally acting neuromodulators= mirtazapine

epigastric pain syndrome
PPI
Amitryptyline

Question 3

IBS characterization

Answer 3

recurrent abdominal pain and abnormal defecation in the absence of structural abnormalities of the gut
cause of frequent absenteeism of work and impaired quality of life

Question 4

pathophysiology of IBS

Answer 4

behavioural and psychosocial
physiological
luminal factors

Question 5

IBS-D and IBS-C
which serotogenic disorder involved
rx for both of them

Answer 5

IBS-D= diarrhoea predominant
rx: 5HT3 antagonist
IBS-C= constipation predominant
rx: 5HT4 antagonist

Question 6

IBS classification by bowel habit

Answer 6

IBS-D
IBS-C
IBS-M
IBS-U

Question 7

SS of IBS

Answer 7

Recurrent abdominal pain: colicky, cramping and lower abdomen

altered bowel habit: Constipation with pellety stools and abdominal pain or proctalgia
diarrhoea frequent low volume and no noctural symptoms, mucus discharge not blood.
non git symptoms: migraine headaches, dyspareunia and interstitial colitis

Question 8

✳️IBS investigations

Answer 8

ROME IV criteria
with no alarm features

Question 9

✳️ROME IV criteria

Answer 9

recurrent abdominal pain for at-least 1 day in a week for last 3 months (onset atleast 6 months before diagnosis) with following 2 or more
related to defecation
onset associated with a change in frequency of stool
onset associated with a change in appearance of stool

Question 10

✳️Alarm features of suspected IBS

Answer 10

-age >50 years
-unintentional weight loss
-palpable abdominal mass or lymphadenopathy
-nocturnal symptoms
-recent change in bowel habits
-Family history of colon cancer or IBD
-Anaemia
-evidence of overt GI bleeding (Malena or haematochezia)

Question 11

in IBS what should be done if alarm features are present..

Answer 11

Colonoscopy

Question 12

✳️When IBS confirmed what to do?

Answer 12

Reassurance

Question 13

IBS-D treatment plan?

Answer 13

Avoid legumes and high dietary fibers
Low FODMAP diet and gluten free diet
If symptoms persists then
Loperamide or codein sulphate or cholestyramine
If symptoms persists then
Amitryptyline or imipramine or rifaximine
Then
Duloxeitine or relaxation therapy or biofeedback or hypnotherapy

Question 14

IBS-C rx?

Answer 14

High rughae diet
If symptoms persists
Ishapgula or psyllium or lactulose or macrogol
If symptoms persists
Prucalopride or linaclotide
Then
Duloxeitine or relaxation therapy or biofeedback or hypnotherapy

Question 15

IBS with pain and bloating

Answer 15

Dietary change
Low FODMAP
Exclude wheat, dairy or gluten
If symptoms persists
Spasmodics drugs like
Meveberine, pepermint oil, hyocine,probiotics, rifaximin, amitryptyline or imipramine
Then
Duloxeitine or relaxation therapy or biofeedback or hypnotherapy