IBS Flashcards
1
Q
Irritable bowel syndrome is a combination of the three following factors
A
- altered GI motility
- smooth muscle hypermotility
- visceral hyperalgesia
- increased perception of visceral pain
- increased perception of normal motility
- psychopathology
- co-morbid psychological issues
2
Q
Irritable bowel syndrome comes in what 3 types
A
- constipation-predmoninant
- diarrhea-predominant
- pain-predominant
3
Q
hallmark signs/symptoms of Irritable bowel syndrome
A
- abd pain relieved by defecation
- pain associated with looser or more frequent stools
4
Q
clinical presentation
- lasts for days/months with periods of normal bowel function or diarrhea
- stools are hard and may be followed by sensation of incomplete evacuation
- strain with defecation
A
constipation predominant IBS
5
Q
clinical presentation
- frequent loose stools
- typically occurs in morning and after meals
- preceeded by urgency and may be followed by sensation of incomplete evacuation
- mucus discharge with stool
A
diarrhea-predominant IBS
6
Q
clinical presentation
- crampy abd pain of variable intensity with periodic exacerbations
- alternating diarrhea and constipation
- stress and eating may exacerbate, defecation provides relief
A
pain-predominant IBS
7
Q
what criteria can be used to evaluate IBS
A
- Rome criteria III: recurrent abd pain at least 3 days per month in the last 3 months and associated with 2 or more of the following
- improvement with defecation
- change in frequency of stool
- onset associated with a change in form (appearance) of stool
8
Q
ABC diagnosis of IBS
A
- Abdominal pain
- Bloating
- Change in bowel habits/stool consistency
9
Q
red flags when assessing for IBS
A
- FHx of colon CA, IBD, or celiac disease
- Anemia, GI bleed
- Weight loss
- fever, vomiting
- dysphagia
- steatorrhea
- nocturnal symptoms
- h/o abx use
- recent travel
10
Q
are labs/diagnostics usually done to assess IBS
A
- not routinely recommended unless there are alarm features
- CBC
- CMP
- ESR, CRP
- TSH
- Hemocult
- Stool studies: ova and parasites
11
Q
management options for all types of IBS
A
- reassurance: legitimize complaint
- large placebo effect
- anticholinergic (antispasmotic)
- Bentyl
- Fiber supplement
- stress management
12
Q
rome criteria for diagnosis of constipation
A
- stool frequency (< or = 2 stools per week), straining, hard stools, and a feeling ofi ncomplete evacuation
13
Q
3 common causes of constipation
A
- slow-transit constipation
- slow movement from proximal to distal colon
- pelvic floor dysfunction
- medication
14
Q
physical exam for constipation should include
A
- anal reflex: anal “wink” -> as finger touches anus, it closes
- DRE
- pelvic exam: evaluate for rectocele -> evidence of pelvic floor dysfunction
15
Q
managment of constipation
A
- increase activity/exercise
- increase fiber to 20-30g/d
- minimize laxative use
16
Q
complications of constipation
A
- fecal impaction
- large bowel obstruction
17
Q
differentiate betwee acute and chronic diarrhea
A
- acute: < or = 14 days in duration
- chronic: > 30 days in duration
18
Q
most common etiology of acute diarrhea
A
-
viral
- rotavirus, adenovirus, norwalk-like virus
- bacterial causes tend to be more severe
19
Q
How does Noninflammatory diarrhea present
A
- diffuse, watery diarrhea with abdominal cramping, N/V and fever
20
Q
list the pathogens that causes of Noninflammatory diarrhea
A
- norwalk-like virus
- rotavirus
- adenovirus
- Giardia
21
Q
how does inflammatory diarrhea present
A
- fever and bloody diarrhea, LLQ pain and tenesmus
22
Q
list pathogenic causes of inflammatory diarrhea
A
- shigella
- salmonella
- campylobacter
- enterohemorrhagic Ecoli
- C diff
23
Q
list the red flags of diarrhea
A
- bloody diarrhea
- uncontrolled diarrhea
- passage of > or = 6 unformed stools in 24 hr
- fever
- dehydration
- elderly
- immunocompromised
24
Q
List the stool studies
A
- fecal leukocytes
- ova and parasites
- done if symptoms > 7 d
- bacterial culture (salmonella, campylobacter, shigella)
- blood or fever
25
what lab test is done when assessing diarrhea in patients with a h/o travel or MSM
stool wet mount (r/o amebiasis)
26
what lab test is done when assessing diarrhea in patients with a h/o recent abx
* stool cytotoxicity assay for C-diff
27
what pathogen commonly causes viral gastroenteritis in children \< 2 yo
rotavirus
28
transmission of campylobacter
* food borne ilness
29
campylobacter can increase risk of what condition
guillian-barre syndrome
30
tx for camplylobacter cause of acute diarrhea
erythromycin
31
how is shigella transmitted
* food
* water
* direct contact
32
tx of acute diarrhea caused by shigella
bactrim
33
clinical presentation
* bloody diarrhea
* abdominal pain
* **no fever**
* enterhemorrhagic ecoli O157:H7
34
what lab must you request when assessing for Ecoli O157:H7
stool culture for E coli O157:H7
35
Ecoli O157:H7 can cause what complication in children
* hemolytic uremic syndrome
36
hemolytic uremic syndrome presents in what triad
* acute renal failure
* mircoangiopathic hemolytic anemia
* thrombocytopenia
37
most significant risk factor of C-diff
* abx use within the past 3 months
38
C-diff produces a toxin that does what
* binds to epithelial lining of GI tract to form pseudomembranes
39
how is C-diff diagnosed
cytotoxicity assay
40
managment of C-diff
* stop offending abx
* avoid antimotiltiy agents to allow toxin to clear
* metronidazole
41
bloody diarrhea is most commonly associated with which pathogen
enterohemorrhagic Ecoli
42
noninflammatory diarrhea with vomiting suggests what condition
* viral enteritis
* food poisoning
