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Flashcards in IBS Deck (25):
1

How is IBS characterized?

chronic abdominal pain + altered bowel habits in the absence of any known organic cause

2

Epidemiology of IBS?

Female :Male 2:1

symptoms at <45 years of age

3

Pathophysiology of IBS? (5)

- Motility disorder
- Visceral Hypersensitivity
- Intestinal Inflammation
- Intestinal Microbial changes
- Psychological

4

Main culprit of symptoms on IBS?

abn colonic motility

5

What causes pain in IBS?

Increased visceral sensitivity to pressure and pain stimulus

6

What IBS symptoms may result from slow GI transit?

bloating and distension (which are painful due to hypersensitivity)

7

How can we tell intestinal inflammation may be present in IBS?

increased inflammatory markers (TNF and other cytokines)

8

What microbial abn may be present in IBS?

Post Infectious IBS

Alteration in Gut microbes

Bacterial Overgrowth

9

IBS patients tend to be more freq diagnosed with:

psychological disorders
(particularly, abuse)

10

Possible mediating factor related to IBS and psych disorders?

Corticotropin Releasing factor

11

Rome III Diagnostic Criteria for Irritable Bowel Syndrome Irritable Bowel Syndrome:

Recurrent abd pain or discomfort for 3 consecutive days a month in last 3mo associated with 2 or more of the following:

• Improvement w/ defecation
• Onset asst'd w/ change in freq of stool
• Onset asst'd w/ change in appearance of stool

12

According to the Manning criteria, likelihood of IBS increases with presence of what symptoms?

1. Pain relieved with defecation
2. More frequent stools at onset of pain
3. Looser stool at the onset of pain
4. Visible abdominal distention
5. Passage of mucus
6. Sensation of incomplete evacuation

13

IBS-C is associated with...

IBS-D is associated with...

Hard stool >25% of stool

Loose/watery stool >25% of stool

14

Mixed IBS is associated with...

Loose and hard stool alternate >25% each

15

Diarrhea in IBS is defined/characterized as...

frequent (>3 stools/day) non-bloody stools of small volume that may be associated with urgency or feeling of incomplete evacuation

16

What is the timing of diarrhea in IBS?

Usually AM or post-prandial, but does NOT awaken patient

17

Constipation in IBS is defined/characterized as...

< 3 stools/week which may be hard/pellet

Constipation may be constant or intermittent

18

Most frequent type of altered bowel habits seen in IBS?

Alternating Diarrhea/Constipation

19

Differential Diagnosis of Irritable Bowel Syndrome (FYI)

Abx-associated diarrhea
Hypo/hyperthyroidism
Medications
Endometriosis
Celiac Sprue
Lactose intolerance
Infectious diarrhea
Colorectal cancer
Diverticulitis
IBD

20

Red Flags in Diagnosis of IBS in history?

Hx of wt loss, severe chronic diarrhea or constipation, rectal bleeding

Onset of sx in patient >50 y/o

Recent travel or abx use

Family hx of GI cancer, sprue, or IBD

21

Red flags in Diagnosis of IBS in physical/labs?

arthritis, lymphadenopathy, abdominal mass

Anemia, abnormal thyroid tests, abnormal calcium, abnormal liver tests, leukocytosis

22

Treatment of IBS?

- Education
- Reassurance
- Dietary modification
- Drug treatment (for pain, constipation or diarrhea)
- Psychological treatment

23

Dietary Treatment of IBS?

For some pts: fatty foods, alcohol, caffeine, beans

Food diary

24

Drug treatment of IBS for nml patients?

Fiber (constipation)

Loperamide (symptomatic control of diarrhea)

Anti-cholinergics (pain and bloating)

25

Drug treatment of IBS for severe symptoms?

1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors

**antidepressants modulate GI motility, and may modulate visceral hyperesthesia