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Gastro > IBS + constipation > Flashcards

IBS + constipation Flashcards

1
Q

What causes IBS [3]

A

Unknown cause related to gut sensitivity and altered motility
No inflammation or damage to bowel
Functional (thought to be due to disorders of intestinal motility or enhanced visceral perception)

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2
Q

What brings IBS on [6]

A 
Stress
Anxiety
Depression
Emotional distress 
Menstruation
Gastroenteritis
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3
Q

What sxs are part of diagnostic criteria for IBS

A 
Abdominal pain +2 of 
Relief by defecation
Altered frequency
Altered form - C or D 
>6 months 
and >2 of:
Urgency / straining 
Incomplete evacuation 
Bloating 
Worse after eating 
Mucous / bleeding in stool
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4
Q

What is characteristic of IBS abdominal pain [5]

A 
Radiate to back 
Vague 
Burning 
Rare at night  
Non-cyclical (endometriosis can mimic)
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5
Q

What are other features [4]

A

Lethargy
Nausea
Backache
Bladder issues

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6
Q

What investigations do you perform in IBS [3]

A

Bloods: FBC, ESR, CRP, LFT, coeliac serology, CA-125 if female

Stool: culture if diarrhoea prominent, faecal calprotectin

Colonoscopy if 60+ / alarm symptoms
Refer if FH ovarian / bowel

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7
Q

What is calproctectin

A

Marker of inflammation in mucosa - Differentiates IBD and IBS

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8
Q

How do you treat IBS non-pharmacological [4]

A

Dietic review - FODMAP, lactose, gluten
Exercise
Reduce stress
Psychotherapy if refractory >12 months

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9
Q

How do you treat pain in IBS [2]

A

Anti-spasmodics

Antidepressants - TCA 2nd line or SSRI (also if refractory)

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10
Q

How do you treat bloating [2]

A

Probiotics

Avoid fibre and bulking agents

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11
Q

How do you treat constipation [4]

A

Laxatives
Avoid FODMAP
5HT4
Water + fibre

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12
Q

How do you treat diarrhoea [4]

A

Anti-motility agent
FODMAP
Loperamide = 1stline
Avoid caffeine / alcohol

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13
Q

What are alarm symptoms in IBS requiring colonoscopy [9]

A 
50+, Male
Short history <6 months 
Waking at night with pain/diarrhea
Weight loss
FH Bowel / ovarian ca
Abnormal CRP, ESR, Low Hb
Rectal bleeding
Mouth ulcers 
Abdominal mass
Recent antibiotic use as decreased diversity
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14
Q

What drugs cause constipation [5]

A 
Opiates
Anti-cholinergic 
Iron 
Diuretic
CCB
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15
Q

What are neurogenic causes of constipation [6]

A 
Neuropathy
Parkinson's
Stroke
MS
Spinal cord injury
Systemic sclerosis
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16
Q

What are organic causes [8]

A 
Strictures
Malignancy 
Diverticulitis 
IBD
Fissure
Prolapse 
Obstruction, Psuedo-obstruction after operation
Gastrostasis due to DM 
Congenital: Hirschsprung
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17
Q

What are systemic causes of constipation [4]

A

Diabetes
Low thyroid
Hyper-calcium
Hypokalaemia

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18
Q

What are functional causes of constipation [5]

A 
Mega-colon
Depression
Psychosis 
Pain 
No toilet
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19
Q

What are other causes of constipation [6]

A 
Lack of fibre
Lack of exercise
Unhealthy BMI
Dehydrated
Age 
Hospital / post-op
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20
Q

How do you Dx constipation [4]

A

DRE (impaction, rectal tumor)
Abdo exam (mass, tenderness)
FBC, ESR, U+E, Ca, TFT
Colonoscopy if suspected malignancy

21
Q

How do you treat constipation [6]

A

Lifestyle advice - drink more, high fibre
Diet advice
Bulking agent e.g. fibrogel
Oral laxative
Suppository
Phosphate Enema - useful if impacted before use laxative

22
Q

What are complications of constipation [5]

A 
Haemorrhoids
Faecal impaction
Bowel incontinence / overflow
Acute urinary retention 
Delirium
23
Q

What is 1st line laxative

A

Stimulant e.g. senna to increase motility

24
Q

What is 2nd line

A

Senna + laxido

25
Q

What is next line

A 
Isotonic = movical
Osmotic = lactulose to retain fluid
26
Q

What are other options [3]

A

Pro-kinetic drugs
Metaclopramide (D2) - useful in pseudo
Azithromycin

27
Q

When is metaclopramide CI

A

Obstruction as risk of perforation

28
Q

What do you do for gastroporesis [5]

A 
NBM
NG tube 
TPN if longer
Change meds to IV if NG tube 
Depact colon
29
Q

What does laxative abuse cause

A

Melanosis coli

Pigment laden macrophages

30
Q

What suggests further investigation [4]

A

Weight loss
MASS
PR Blood
Anaemia

31
Q

What is constipation

A 
<3 stool a week
Difficulty passing
Pain
Bloating
Incomplete
32
Q

What shows degree of obstruction

A

Can they pass wind

33
Q

What is small bowel overgrowth syndrome

A

Excessive amounts of bacteria in small bowel

34
Q

How does it present [5]

Small bowel overgrowth

A 
Chronic diarrhoea
Bloating
Flatulence
Abdominal pain
Similar to IBS
35
Q

Who is at risk [3]

A

Neonates with GI abnormality
Scleroderma
DM

36
Q

What is 1st line test

A

Hydrogen breath test

37
Q

How else do you Dx

A

Small bowel aspiration and culture = diagnostic
Stool culture
Bile acid breath
Endoscopy

38
Q

How do you treat

A

Ax?
Rifaximin
Metronidazole
Co-amox

39
Q

What is normal BMI

A

18.5-25

40
Q

What is overweight

A

25-30

41
Q

What is obese

A

30+

42
Q

What is underweight

A

<18.5

43
Q

What are options [3]

A

Gastric band
Gastric bypass
Sleeve gastrectomy

44
Q

What is gold standard

A

Combination - roux en y bypass

45
Q

What does a gastric band do [4]

A

Decrease size of stomach by a band
Minor op
Reversible
Risk of prolapse

46
Q

What does a bypass do? [2]

Side effects [2]

A

Bypass segments of bowel
Leads to quick weight loss
SE: Dumping syndrome
Malabsorption

47
Q

What does a sleeve gastrectomy do [3]

A

Removes part of stomach
More invasive
No dumping syndrome or foreign body

48
Q

What are the complications of gastric surgery [5]

A 
Anastomotic leak
DVT / PE, Infection
Malnutrition
Vitamin deficiency 
Hair loss

Gastro (17 decks)

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