IBS

Question 1

What age does IBS MCly occur in?

Answer 1

18-34 y.o.

Question 2

What is imperative to screen for in IBS?

Answer 2

1. Depression
2. Suicidal ideation

*Psychiatric disease can co-exist with IBS

Question 3

What can look exactly like IBS? What should you screen the pt for to rule this out?

Answer 3

Celiac Disease

IgA TTG or celiac panel

Question 4

What is a Traditional IBS diet

Answer 4

1. Regular meal pattern
2. Avoidance of large meals
3. Reduced intake of: fat, insoluble fibers, caffeine, gas-producing foods (beans, cabbage, onion)

Question 5

What can you consider in patients with mild and intermittent sx’s?

Answer 5

Lifestyle & diet modification:

1. IBS diet
2. Exlcusion of gas-producing foods
3. Avoid lactose and/or gluten
4. Fiber/psyllium: Citrucel, Metamucil

Question 6

IBS with predominant constipation (IBS-C) pharmacology treatment

Answer 6

1. Osmotic laxatives: Miralax (polyethylene glycol)

2. Lubiproston: Local acting chloride channel activator

Question 7

What is first line treatment in IBS with predominant diarrhea (IBS-D)

Answer 7

1. Antidiarrheal agents: Loperamide (Imodium)

Question 8

What can you consider in pt’s with IBS-D post cholecystectomy?

Answer 8

Bile Acid Sequestrants

Question 9

Treatment for abdominal pain and bloating in IBS?

Answer 9

Antispasmodics:

1. Diclyomine
2. Hyoscyamine

Question 10

What Antidepressant can you consider in IBS-D who have failed other treatments?

Answer 10

TCA’s

Question 11

What Antidepressant can you consider in IBS-C who have failed other treatments?

Answer 11

SSRI’s: Sertraline (Zoloft)

Question 12

What can you consider in pt’s with IBS WITHOUT constipation AND with significant bloating?

Answer 12

Abx: Rifaximin

Question 13

What makes a significant improvement in a pt’s prognosis with IBS?

Answer 13

Positive patient-provider relationship

Question 14

What is the MC digestive complaint in the vernal population?

Answer 14

Constipation

F>M

Question 15

How can you differentiate constipation from IBS-C?

Answer 15

NO PAIN

Question 16

Constipation etiology

Answer 16

1. Slow-transit constipation
2. Pelvic Floor dysfunction
3. Mediations: Opioids

Question 17

In refractory pt’s with constipation, what diagnostic studies can you consider?

Answer 17

1. Colonic Transit Study: Rate of radiopaque marker moving through the colon
2. Anorectal manometry: Sphincter pressure

Question 18

What laxatives can you consider in constipation?

Answer 18

1. Osmotic laxatives: PEG (Miralax)
2. Saline: Milk of Magnesium
3. Emollient: colic
4. Stimulant: Senokot
5. Stimulant + Emollient: Peri-colace

Question 19

What can fecal impaction lead to?

Answer 19

Large bowel obstruction

Question 20

Define Acute Diarrhea

Answer 20

< 14 days

Question 21

Define Persistent Diarrhea

Answer 21

> 14 days, but <30 days

Question 22

Define Chronic Diarrhea

Answer 22

> 30 days

Question 23

What is the leading cause of childhood death?

Answer 23

Acute diarrhea

Question 24

What is the MCC for acute diarrhea?

Answer 24

Viral:

1. Rotavirus
2. Adenovirus
3. Norwalk-like virus

Question 25

Inflammatory diarrhea etiology

Answer 25

Bacterial: 1. Campylobacter 2. Salmonella 3. Shigella 4. Enterohemorrhagic E coli

Question 26

What is the MC protozoa etiology in diarrhea?

Answer 26

Giardia

Question 27

Define non-inflammatory acute diarrhea

Answer 27

1. Diffuse, watery diarrhea 2. Abdominal cramping 3. N/V 4. Fever

Question 28

Non-inflammatory acute diarrhea causes

Answer 28

1. Giardia 2. Norwalk-like virus 3. Adenovirus

Question 29

Define Inflammatory acute diarrhea

Answer 29

1. Bloody diarrhea 2. LLQ pain 3. Tenesmus

Question 30

What is blood diarrhea MCly associated with?

Answer 30

Enterohemorrhagic E coli

Question 31

What is an important cause of viral gastroenteritis in children <2, but can also infect adults?

Answer 31

Rotavirus

Question 32

What does Noninflammatory diarrhea with vomiting suggest?

Answer 32

viral enteritis | food poisoning

Question 33

What does Proctitis and rectal discharge suggest?

Answer 33

1. Gonorrhea | 2. LGV: lymphogranuloma venereum (unique strain of chlamydia)

Question 34

What is the main E.coli strain in the US in Enterohemorrhagic E coli?

Answer 34

E.coli O157:H7

Question 35

What is Enterohemorrhagic E coli associated with?

Answer 35

Hemolytic Uremic Syndrome: 1. Hemolytic anemia 2. Renal failure 3. Thrombocytopenia

Question 36

Enterohemorrhagic E coli (EHEC) clinical presentation

Answer 36

1. NO fever 2. Bloody stool 3. Abd tenderness

Question 37

Giardia classic sx's

Answer 37

1. Persistent diarrhea >7 days 2. Fatty stools 3. Contaminated water hx=camping

Question 38

If you suspect EHEC, what test must you order?

Answer 38

1. Culture for E.coli O157:H7 2. Stool test for Shiga toxin

Question 39

If C. diff is suspected, what must you order?

Answer 39

Stool for C. diff toxin

Question 40

If Giardia is suspected, what must you order?

Answer 40

Stool for Giardia Ag (antigen)

Question 41

What is the most important priority in treating pt's with acute diarrhea?

Answer 41

Rehydration!

Question 42

List symptomatic treatment options in acute diarrhea

Answer 42

1. Loperamide: Imodium | 2. Bismuth Subsalicylate: Pepto-Bismol

Question 43

Who should you avoid giving Loperamide (Imodium) to? Why?

Answer 43

Pt's with suspected inflammatory disorder | May facilitate HUS in pt's with EHEC

Question 44

What must you complete first before starting empiric abx?

Answer 44

Stool testing

Question 45

Who are you going to consider abx in?

Answer 45

1. Benefits>risk 2. Pt @ risk for complication: immunocompromised 3. Mod/Severe diarrhea suspicious for inflammatory diarrhea, BUT EHEC or C.diff NOT suspected

Question 46

List the empiric abx in the treatment of acute diarrhea

Answer 46

Ciprofloxacin OR Azithromycin x3-5 day s