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