16 - IBS Flashcards by Aygin Sehat

IBS

functional bowel disorder
abdominal pain and discomfort
altered bowel habits

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علائم

recurrent abdominal pain and discomfort 
episodic and crampy 
با خوردن و استرس بدتر میشه 
بهبود همراه با مدفوع کردن 
شروع درد همراه با تغییر در فرکانس مدفوع 
شروع درد همراه با تغییر در شکل مدفوع 
postprandial pain

defecation straining 
urgency 
feeling of incomplete bowel movement 
passing mucus 
bloating

علائم معمولا در بیداری
دیسفاژی
سوزش سر دل
تهوع استفراغ

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post infectious IBS بیشتر توسط کدوم باکتری ها

کمپیلو باکتر
شیگلا
سالمونلا

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کدوم فلور های نرمال کاهش کدوم ها افزایش پیدا کردن ؟

کاهش
genera bifidobacterium
lactobacillus

افزایش
firmicutes . bacteroidetes

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اگر درد در اپی گاستر و اطراف ناف باشه تشخیص های افتراقی اش ؟

بیماری مجاری صفراوی
زخم معده
ایسکمی روده
کارسینومای معده / پانکراس

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اگر درد بیشتر در پایین شکم باشد تشخیص های افتراقی ؟

دایورتیکول کولون
IBD
کارسینوما کولون

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postprandial pain تشخیص های افتراقی

گاستروپارزی
انسداد مقطعی روده
عفونت روده ای با ژیاردیا

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تشخیص های افتراقی اسهال

لاکتاز کمبود 
استفاده زیاد از مسهل 
سوء جذب 
سلیاک 
هیپرتیروئیدی 
IBD
اسهال عفونی

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یبوست تشخیص افتراقی

استفاده از دارو هایی مثل
انتیکولینرژیک
انتی هایپرتنسیو
ضد افسردگی

اندوکرینوپاتی
هیپوتیروئیدی
هیپوپاراتیروئیدی

acute intermittent porphyria
مسمومیت با سرب

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تست های تشخیصی IBD

CBC
سیگموئیدسکوپی
کشت مدفوع برای تخم و انگل
بیوپسی سیگموئید در اسهال پرسیستنت مقاوم به درمان

ددر صورت سن بالای 40 سال:
air contrast barium enema
colonoscopy

تست هیدروژن تنفسی
3 هفته رژیم بدون لاکتوز

رژیم بدون گلوتن

upper GI radiography
در کسانی که دیس پپسی دارند

esophagogastroduedonalscopy
در کسانی که دیس پپپسی دارند

ultrasonogram of the gallbladder
در کسانی که
postprandial pain in RUQ

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یسک فاکتور های

arterio occlussive mesentric ischemia

AF
recurrent myocardial infarction
valvular disease
recurrent cardiac or vascular catheterization

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embolic clot ها در کدوم ایسکمی

arterio occlussive mesentric ischemia

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gold standard تشخیص

arterio occlussive mesentric ischemia

angiography

laparotomy

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intestinal angina

non occlussive mesentric ischemia

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non occlussive mesentric ischemia

در ؟

یکهویی در سنین پیری
atherosclerotic
increased dose vasopressin
cardiogenic / septic shock cocaine overdose

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علائم

non occlussive mesentric ischemia

generalized abdominal pain 
bloody stool 
anorexia
abdominal distention 
لوکوسیتوز
اسیدوز متابولیک
افزایش امیلاز 
افزایش کراتینین فسفاتاز 
لاکتیک اسید

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در کدوم مدل اصلا وازوکانتریکتور نباید بدیم در ایسکمی ها

non occlusive mesenteric ischemia

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کدوم ارتباط بالا با ischemic colitis داره

non occlusive mesenteric ischemia

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mesenteric venous thrombosis در

hypercoagulative state 
(pr c , s antitrypsin 3 deficiency )

polycythemia
carcinoma

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در کدوم ایسکمی

clot in sup. mesenteric

mesenteric venous thrombosis

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gold standard تشخیصی

mesenteric venous thrombosis

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Angiography mesenteric

Griffiths point

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خمیدگی اسپلنیک

مهم ترین نقاط ایسکمی

sudech’s point

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خمیدگی سگموئید و رکتوم

مهم ترین نقطه ایسمنی

دو نقطه مهم ایسکمی

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Griffiths point

sudech’s point

SMA occlusive

superior mesenteric artery (SMA) کمی پایین تر از خروج middle colic artery

علائم | acute mesenteric ischemia

``` severe acute non remitting abdominal pain تهوع استفراغ اسهال موقت anorexia bloody stool abdominal distension hypoactive bowel sound peritonitis cardiovascular collapse ```

early features رادیوگراقی | acute mesenteric ischemia

ادم دیواره bowel | thumbprinting

ischemia of colonic mucosa is graded as :

mild اریتم کم موکوس moderate pale mucosal ulceration . تهاجم به لایه ماهیچه ای severe : ischemic colitis + severe ulceration ( frank necrosis)

بهترین پروگنوز بین همه این ایمسکمی ها

mesenteric venous insufficiency

علائم | chronic intestinal ischemia

``` weight loss حتمی chronic diarrhea intestinal angina postprandial abdominal pain درد کرمپی بعد از خوردن غذا ```

یافته های بالینی در | chronic intestinal ischemia

malnourished patient abdominal bruit atherosclerosis

Acute mesenteric ischemia (AMI) is

a syndrome in which there is acute onset of inadequate blood flow through the mesenteric vessels, which commonly results from occlusion or hypoperfusion to the vessels.

Common causes of acute mesenteric ischemia include:

Arterial thrombus due to atherosclerosis (most common) Venous thrombus due to hypercoagulable states (polycythemia vera, pregnancy, protein C and S deficiency, etc) Arterial occlusion due to emboli from arrhythmia or post-cardiac catheterization Hypoperfusion due to blood loss or CHF

Chronic mesenteric ischemia (CMI) is

ischemia of the bowel due to long-standing atherosclerotic disease of 2 or more mesenteric vessels. Vasculitides may also cause chronic mesenteric ischemia.

The three vessels that may be affected in chronic mesenteric ischemia are

celiac trunk, superior mesenteric artery, inferior mesenteric artery.

In patients with acute mesenteric ischemia, symptoms may include:

Non-localized, diffuse, and constant abdominal pain Nausea Vomiting Bloody diarrhea

In chronic mesenteric ischemia, patients present with:

``` Postprandial pain (epigastric or periumbilical) Fear of eating (sitophobia) Weight loss History of vascular disease Nausea, vomiting, diarrhea ```

On physical exam, patients with acute mesenteric ischemia may have the following:

``` Pain disproportionate to physical exam findings Abdominal distention Fever Hypotension Tachycardia Altered mental status Positive fecal occult blood ```

On physical exam Patients with chronic mesenteric ischemia may have the following:

Pain disproportionate to physical exam findings Abdominal bruit Decreased peripheral pulses Signs of weight loss

The gold standard for diagnosis of acute or chronic mesenteric ischemia is

CT angiography.

In both acute and chronic mesenteric ischemia, laboratory studies are typically non-specific, but may include:

Elevated WBC count with left shift Increased lactate dehydrogenase Elevated amylase Metabolic acidosis Elevated hematocrit due to hemoconcentration Prothrombin time, activated partial thromboplastin time, and international normalized ratio abnormalities

in chronic mesenteric ischemia, the following may be found:

Anemia, leukopenia, lymphopenia due to chronic malnourishment Hypoalbuminemia due to malnourishment Electrolyte abnormalities due to vomiting, diarrhea, or malnutrition

Acute mesenteric ischemia may result in:

``` Bowel necrosis Perforation Peritonitis Sepsis Death ```

Ischemic colitis is

ischemia and necrosis of the large intestine secondary to vascular compromise.

There are 3 degrees of infarction:

Mucosal infarction Mural (submucosal infarction) Transmural infarction

Mucosal and mural infarctions are generally due to

hypoperfusion.

Acute transmural infarction may present with:

``` Sudden severe abdominal pain Abdominal muscular rigidity Nausea Vomiting Bloody diarrhea Melena ```

risk factors include:

``` older patients with concomitant cardiac or valvular disease Diabetes mellitus Atherosclerosis Congestive heart failure Peripheral vascular disease Lupus ```

Chronic ischemia may closely mimic

inflammatory bowel disease.

Diagnosis may be done by:

Colonoscopy: may see bloody and edematous mucosa | CT scan: may show air within bowel, bowel wall thickening, or thumb-printing (see image)

Complications of ischemic colitis include:

Bowel tissue death Perforation Bowel inflammation Bowel obstruction (strictures)

Treatment consists of: ischemic colitis

Bowel rest IV fluids IV antibiotics

16 - IBS Flashcards

(52 cards)