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FAMILY MEDICINE > IBS > Flashcards

Flashcards in IBS Deck (11):
1

"Alarm features" of GI upset

fever, weight loss, bloody stools, refractory diarrhea, family hx of ovarian or colon cancer, hx of celiac, or IBD

ask for these before diagnosing IBS...these usually point to underlying pathology

2

Environmental and host factors that may contribue to IBS

environmental - hx of abuse/stressors, food intolerance, enteric infections, antibiotic use

host - altered gut permeability, gut immune hyperactiivty, altered gut flora, altered gut pain sensitivity, dysregulation of brain-gut axis during stress

3

IBS usually occurs with what other diseases

fibromyalgia, chronic headaches, lower back pain

4

Typical presentation of IBS

Woman, 20-30 years old
predominant pattern of constipation, diarrhea, alternating diarrhea/constipation or periods of normal bowel habits that alternate with either diarrhea/constip/both....usually presents with crampy abd pain (location varies) that is relieved by defecating

5

What criteria is used to diagnose IBS?

Rome III criteria

6

ROME III criteria

recurrent abd pain/discomfort for at least 3days/month for the past 3 months with at least 2 of the following
- improvement with defecation
- change in shape/form of stools
- chang ein frequency of stools

criteria fulfilled for the previous 3 months with symptom onset at least 6 months ago

7

What labs to draw when evaluating IBS

- CBC, age approp colon cancer screening
- (in cases with diarrhea/mixed subtype), CRP and celic (igA tissue transglutimase antibody or antiendomysial antibody))
- can also test for bile malabsorption
- CA-125 in pt with family hx of ovarian cancer

8

Treatment options for IBS with abdominal pain

- antisapasmodic (dicyclomine or hyoscyamine) prn (first line for abdoinal pain)
- low dose TCA or SSRI when comorbid with depression/anxiety or if pain is very severe
- rifaximin; as long as pt DOES NOT have constipation
- probiotics/peppermint oil

9

Treatment options for IBS with constipation predominant

- soluble fiber (dietary, synthetic, or naturla)
- polyethylne glycol
- lubiprostone (activates intestinal chloride channels and increases fluid secretion
- linaclotide - increases motility and fluid secretion (expensive)

10

Treatment options for IBS with diarrhea predominant

- loperamide (imodium)
- rifaximin; used for traveler's diarrhea, bacteriostatic gut specific
- alosetron - severe diarrhea of at least 6 months

11

What treatment is common to all subtypes and patients with IBS

behavioral therapy and lifestyle modifications!!!! patient's mental state actively influences symptom