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Exam 1 Year 3 > IBS > Flashcards

IBS Flashcards

1
Q

What is the cause of IBS?

A

*Cause is not understood
*Food intolerance -lactulose/gluten
*Gut is not damaged / diseased
*Post infective bowel dysfunction, gut hypersensitivity, altered colonic motility, heightened pain sensation all implicated
*Stress commonly implicated
-After gastroenteritis 1/6 get IBS

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2
Q

What are the cells like in the gut in someone with IBS?

A

*The gut is normal
*‘Functional’ Gi disorder
*No detectable using standard tests

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3
Q

What tests do you need to have to rule out other conditions?

A

Blood tests, stool samples, colonoscopy

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4
Q

What type of treatment do functional conditions require?

A

Symptom management

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5
Q

What are the symptoms of IBS?

A

Cramping, Diarrhoea, constipation (can alternate), flatulence, bloating, urgency to defecate, acid indigestion, nausea, lethargy,

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6
Q

Can you pass mucus in your stool with IBS?

A

Yes

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7
Q

Can eating worsen IBS symptoms?

A

Yes

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8
Q

How many months of pain/symptoms is used to diagnose IBS?

A

6 months

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9
Q

If defecating relieves the pain is this a sign of IBS?

A

Yes

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10
Q

Is there is increased/decreased bowel frequency in IBS?

A

Yes

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11
Q

What other symptoms can aid in the diagnosis of IBS?

A

1) Abdo bloating / distension
2) Altered stool passage (straining, urgency, incomplete evacuation)
3) Worsened by eating
4) Passing mucus

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12
Q

What is the criteria is used in secondary care for IBS diagnosis?

A

Rome IV criteria

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13
Q

What is the Rome IV criteria in IBS?

A

-Abdo pain 1 day per week in the last 3 months
-Symptoms began at least 6 months prior
-Alongside having 2 of the following
*Related to defecation
-Change in stool frequency
-Change in stool form

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14
Q

A patient has >25% of stools that are type 1/2, and (less) than <25% are types 6/7, what IBS is this?

A

IBS-C

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15
Q

If a patient has stool which is (more)>25% of stools are types 6/7 and (less) <25% are types 1/2

A

IBS-D

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16
Q

IF >25% of stools are types 1/2 and >25% (more) of stools are types 6/7 what IBS is this?

A

IBS-M (mixed)

17
Q

IF a person has IBS but the bowel habits can’t be categorised as above what IBS is this?

A

IBS-U (unclassified)

18
Q

What antispasmodic drugs are used in IBS?

A

*Alverine Citrate 60-120mg up to TDS
*Mebeverine 135mg TDS (20 mins before food) or 200mg BD for M/R preps
*Peppermint oil capsules, 1-2 up to TDS

19
Q

What drugs can be used for IBS but tent to have antimuscarinic effects?

A

Hyoscine butylbromide and Dicycloverine

20
Q

What drugs are contraindicated with intestinal obstruction or paralytic ileus?

A

Hyoscine butylbromide and Dicycloverine

21
Q

What drug is very effective for IBS, but can cause constipation?

A

Hyoscine

22
Q

Are antidepressants licenced for IBS?

A

No

23
Q

When are antidepressants given for IBS?

A

Not shown response for typical treatments

24
Q

What is 1st line antidepressant for someone with IBS?

A

Tricyclic Antidepressants - Amitriptyline 10-30mg at night

25
Q

What is the 2nd line antidepressant for someone with IBS?

A

SSRI (Sertraline, Citalopram, Fluoxetine)

26
Q

What type of IBS are laxatives given?

A

IBS-C

27
Q

What laxative must you not use for IBS?

A

Lactulose, as this can increase gas production and worsen symptoms.

28
Q

What type of IBS is Loperamide given for?

A

IBS-D

29
Q

How long can you give Loperamide for OTC?

A

12mg OD for 48 hours.

30
Q

When is Linaclotide given?

A

For IBS-C in adults, the patient must have had IBS-C for at least 12 months
–> should only be used if max tolerated doses of laxatives haven’t helped

31
Q

What is the dose of Linaclotide?

A

290mcg OD for 30 mins before food

32
Q

When should you avoid Linaclotide?

A

In people with GI obstruction/IBD

33
Q

MOA of Mebeverine?

A

It specifically acts on smooth muscle, blocks voltage operated sodium channels, this prevents build up of intracellular calcium, this reduces symptoms of colonic hypermotility.

34
Q

MOA of Linaclotide?

A

1) Guanylate cylcase0c (GC-C) agonist
2)GC-C activation leads to increased production of cyclic guanosine monophosphate (cGMP)
3)Increased cGMP stimulates the cystric fibrosis transmembrane conductance regulator (CFTR) ion channel
4) CFTR ion channel increases secretion of chloride and bicarbonate into the intestinal lumen, to increase moisture
5) GI transit increased

Basicalyl
GC-C –> cGMP –> increase CFTR action –> Increase intestinal chloride and bicarb

35
Q

What is the red flags requiring referral in IBS?

A

*unintentional weight loss
*unexplained rectal bleeding
*family history of bowel/ovarian cancer
*loose stools for more than 6 weeks in patients above 60
*anaemia
*elevated inflammatory markers
*abdominal / rectal masses

Exam 1 Year 3 (40 decks)

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