IBS

Question 1

Constipation Outline

Answer 1

Symptom (not condition), actute/chronic. Infrequency and difficulty in emptying bowel . Indicated by straining, >3 bowel movements a week and passing herd stools. Risk factors: pregnancy and old age (changing hormones)

Question 2

Indications of constipation severity

Answer 2

patient over 50 years, anaemia, abdominal pain, dry blood in stool (bleeding in intestines) and weight loss

Question 3

Constipation Presentation

Answer 3

Nausea, abdominal swelling, defecation straining and cramping.

Question 4

Constipation Complications

Answer 4

Hemorrhoids, anal fissure, faecal impaction (faeces stuck in GIT), rectal prolapse (rectum sticking out of anus

Question 5

Anal Fissure Outline

Answer 5

Indicated by bright red blood in stool. Tear in anal tissue. Self limiting

Question 6

Heammaroids Outline

Answer 6

Swellings in tissue that enclose blood vessels

Question 7

Constipation Causes

Answer 7

Slowing of food transit in LI (more water absorption, low dietary fibre and water intake, decreased exercise and medication (decreaing intestine motility/secretions, increasing intestinal fluid absorption and bulk/complex formation in GIT (physical barrier))

Question 8

Stool Type that spends longest time in bowel

Answer 8

Type 1

Question 9

Ideal Stool Type

Answer 9

Type 4

Question 10

Stool type that spends least time in bowel

Answer 10

Type 7

Question 11

Constipation Treatment

Answer 11

Lifestyle (increase water/fibre/exercise), laxatives, (secondline) linaclotide and prucalopride

Question 12

Types of Laxatives

Answer 12

Bulk forming, stimulant, faecal softening and osmotic

Question 13

Bulk Forming Laxatives Outline

Answer 13

Useful for patients who can’t increase fibre in diet. Increases fecal mass stimulating paralysis. Action:12-36 hours. Side effects: abdominal distention and flatuelence. Adequate fluid intake essential to avoid obstruction

Question 14

Bulk Laxative Examples

Answer 14

Bran, methylcellulose, ispaghula husk and sterculia

Question 15

Stimulant Laxatives Outline

Answer 15

Stimulant effect on GI mucosa, increasing motility. Onset: 6-12 hours. Side effects: abdominal cramps and nerve damage after long term use. Caution: pregnancy, avoid intestinal obstruction

Question 16

Stimulant Laxative Examples

Answer 16

Bicasydol, sodium picosulfate and senna

Question 17

Fecal Softener Laxatives Outline

Answer 17

Decrease surface tension and increase intestinal fluid penetration into fecal matter

Question 18

Fecal Softener Laxatives Examples

Answer 18

Docusate and glycerol (mild irritant). Liquid paraffin isn’t used as it’s toxic. Onset: 3 days

Question 19

Osmotic Laxative Outline

Answer 19

Increases amount of water in bowel. Either by drawing water into bowel or retaining liquid they were administered with. 2 types: Macrogols and Lactulose. Onset: 1-3 days. Side effects: diahorrea, nausea and abdominal cramps. Require constsnt hydration to avoid dehydration

Question 20

Macrogols Outline

Answer 20

Inert polymers of ethylene glycol which sequestered in bowel fluid. Increasing stool volume, increasing bowel motility

Question 21

Lactulose Outline

Answer 21

Semi-synthetic disaccharide not absorbed by GIT. Lowers pH of gut increasing osmosis

Question 22

Linaclotide Outline

Answer 22

Second line treatment. Guanylate cyclase C receptor agonist. Treats moderate-severe IBSc. Increases fluid secretion and transit, decreasing visceral pain

Question 23

Prucalopride Outline

Answer 23

Selective serotonin 5HT4 receptor agonist (prokinetic qualities). Treats chronic constipation in adults. Risk: renal impairment

Question 24

Diahorrea Def.

Answer 24

Symptom (not disease). Abnormal passing of loose/liquid stool with increased frequency/volume. Typically self limiting

Question 25

Acute Diahorrea

Answer 25

Diahorrea lasting > 14 days. Typically infection caused by gastric mucosa damage or pathogen produced toxin

Question 26

Persistent Diahorrea

Answer 26

Diahorrea lasting 2-4 weeks

Question 27

Chronic Diahorrea

Answer 27

Diahorrea lasting 4+ weeks. Caused by chronic GI disorder (eg Chronn's, colitis, IBS) or medication (osmotic/motility diahorrea)

Question 28

Diahorrea Complications

Answer 28

All linked to dehydration. Confusion, coma, shock, tachycardia, oliguria (reduced urine) and/or anuria (no urine)

Question 29

Diahorrea Red Flag Symtoms

Answer 29

persistent vomiting, weight loss, sleep disruptions and recent hospital visit/ antibiotic course

Question 30

Osmotic Diahorrea Outline

Answer 30

Stop when feeding stops.

Question 31

Secretory Diahorrea Causes

Answer 31

Fluid extensivity due to enterocyte toxin or other inflammatory response

Question 32

Diarrhoea Treatment Aims

Answer 32

Prevent/manage dehydration and avoid/treat cause

Question 33

Oral Rehydration Therapy

Answer 33

Glucose-electrolyte solution. Glucose, sodium and water are absorbed on a 1:1:1 basis. Citrate present to counteract acidosis

Question 34

Loperamide Outline

Answer 34

Antimotility drug. Binds to gut opiate receptors inhibiting ACh and prostaglandin release. This reduces peristalsis rate, increaing transit time. Enhances water reabsorption. Increases anal sphincter tone, improving consistency. Onset: 9-14 days. Only used when patient can't acess a toilet

Question 35

When to not use Loperamide and side effects

Answer 35

Avoid when mucus/blood in stool with high fever, ulcerative colitis and AIDS (risk of toxic megacolon).

Question 36

IBS Outline

Answer 36

Chronic, relapsing condition. Symptoms overlap with a lot of other diseases (abdominal pains, stools change). Varying symptom profiles: IBSC, IBSD and IBSM

Question 37

IBSM Outline

Answer 37

Irritable bowel syndrome where symptoms oscillate between presentation of diahorrea and constipation

Question 38

IBS Diagnostic Criteria

Answer 38

ROME 4 Diagnostic Criteria and NICE Guideline

Question 39

IBS Diagnosis

Answer 39

Recurrent abdominal pain for 1 week every 3 months. Associated with change in frequency/form. Symptom onset was 6 months before diagnosis. Abdominal bloating/distension/hardness/tension and passage of mucus. Made worse by eating

Question 40

IBS Diagnostic Tests Outline

Answer 40

Used to exclude other diagnosises. Full blood count, erythrocyte sedimentation, c-reactive protein and coeliac antibody tests

Question 41

IBS Management: Dietary Advice

Answer 41

Have regular meals, drink 8 glasses of water a day, restrict tea/coffee/fizzy drinks/alcohol drinking. Taoiler to patient eg IBSC = increese in dietary fibre, IBSC = decrease in dietary fibre

Question 42

FODMAP Outline

Answer 42

Substances to avoid when struggling with IBS, as they produce gas. Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Particularly beneficial in IBS with bloating and pain

Question 43

IBS 1st line Pharmacological Therapy

Answer 43

Antispasmodic drugs, laxatives, loperamide and peppermint oil

Question 44

IBS 2nd line Pharmacological Therapy

Answer 44

Tricyclic antidepressents and selective serotonin uptake inhibitor

Question 45

Antispasmodic Outline

Answer 45

Empirically used. Treats smooth muscle spams assumed to be associated with IBS. Eg Hycosine anticholinergic, interacts with M2 and M3 nicotinic receptors