IBS

Question 1

Is iron def anemia assoc with IBS

Answer 1

no

Question 2

Is weight loss assoc with IBS

Answer 2

no

Question 3

IBS: _______ bowel disorder characterized by what?

Answer 3

function

recurrent abdominal pain AND altered bowel habits

Question 4

4 subclassifications of IBS

Answer 4

Constipation predom

Diarrhea predom

Mixed

Unclassified

Question 5

ages IBS affects

Answer 5

20-39

Question 6

M or F predominance with IBS

Answer 6

F

Question 7

Average time to dx IBS

Answer 7

about 4 yrs

Question 8

etiology of IBS

Answer 8

physiological

psychosocial

environmental

Question 9

2 physiological reasons for IBS

Answer 9

abnormal motility

visceral hypersensitivity

Question 10

psychosocial reasons for IBS

Answer 10

early life stressors (like abuse)

anxiety, depression, phobias

Question 11

environmental reasons for IBS

Answer 11

diet, post-infectious, gut microbiome

Question 12

two components needed for IBS

Answer 12

** chronic/recurrent abdominal pain/discomfort

** altered bowel habits (constipation/diarrhea)

Question 13

when does diarrhea happen with IBS

Answer 13

in AM and post-prandially

Question 14

IBS clinical presentation

Answer 14

chronic/recurrent abdominal pain and discomfort

altered bowel habits

+/- dyspepsia, atypical CP, vomiting

Question 15

extra-intestinal symptoms assoc with IBS

Answer 15

sexual dysfunction

dysmenorrhea

irritative voiding symptoms

fibromyalgia

somatic or psyc complaints

Question 16

alarm features of IBS

Answer 16

symptom onset after 50

severe or progressively worsening symptoms

nocturnal diarrhea

fevers/vomiting

unexplained weight loss

melena, hematochezia + occult blood

personal or FH of colon cancer, IBD, or celiac disease

unexplained iron def anemia

Question 17

IBS physical exam

Answer 17

usually normal

tenderness upon palpation on abdominal exam

do perianal and DRE

Question 18

dx criteria for IBS (name of the criteria NOT criteria)

Answer 18

Rome IV

Question 19

Rome IV criteria (what is it?)

Answer 19

recurrent abdominal pain at least one day/week for the last 3 months w/ 2+ criteria:

related to defecation

assoc with change in stool freq

assoc with change in stool form (appearance)

Question 20

IBS dx: typical hx and no alarm features

Answer 20

lab, radiographic, endoscopic tests not routinely recommended

Question 21

IBS dx: if not typical hx or an alarm feature or refractory to tx

Answer 21

CBC, CMP, TSH, ESR/CRP, Celiac serologies, stool studies

cross-sectional/small bowel imaging

endoscopy/colonoscopy with biopsies

Question 22

goal of IBS tx

Answer 22

relieve symptoms and improve quality of life + therapeutic clinician-pt relationship**

dietary/lifestyle measures

psychosocial support

pharm therapy

Question 23

some dietary/lifestyle measures

Answer 23

food diary/symptomatology

dietary fiber (20-35 g/day)

FODMAP diet

Probiotics

Exercise

Question 24

IBS psychosocial support

Answer 24

CBT

Relaxation/stress mgmt

behavioral health referral

Question 25

abdominal pain IBS meds group of side effects

Answer 25

levsin bentyl **anticholinergic effects

Question 26

IBS-C medications

Answer 26

fiber miralax amitiza linzess trulance

Question 27

IBS-D meds

Answer 27

imodium rifaximin viberzi

Question 28

psychosocial IBS meds

Answer 28

TCAs (off label) * crazy side effects

Question 29

3 classes of meds that make constipation worse

Answer 29

antipsychotics iron opioids

Question 30

most common digestive complaint in gen pop

Answer 30

constipation

Question 31

males or females complain of constipation more

Answer 31

females

Question 32

4 risk factors of constipation

Answer 32

improper diet and inadequate fluid intake sedentary lifestyle polypharm increased age

Question 33

6 etiology categories of constipation

Answer 33

functional med-induced slow transit defecation/obstruction metabolic/systemic disease other

Question 34

key history questions for constipation

Answer 34

laxatives? need for digital evacuation? previous colonoscopy red flag symptoms/alarm features reconcile meds/review PMH if needed for secondary/contributing causes of constipation

Question 35

dx criteria for constipation

Answer 35

25% of defecations are: less than 3 spontaneous BM/week lumpy or hard stools straining manual maneuvers anorectal obstruction sensation incomplete evacuation

Question 36

common GI symptoms assoc with constipation

Answer 36

abdominal pain and bloating pain on defecation rectal bleeding tenesmus (anal quivering)

Question 37

red flag symptoms in constipation

Answer 37

acute onset 50+ fevers/vomiting weight loss melena/hematochezia personal or FH of colon cancer, IBD, celiac's iron def anemia

Question 38

what should you do for refractory pts with constipation

Answer 38

colonic transit (radiopaque marker) defecography anorectal manometry

Question 39

adverse effects of fiber

Answer 39

flatulence, bloating, distention

Question 40

adverse effects of osmotic laxatives

Answer 40

GI discomfort, bloating

Question 41

who should you NOT give osmotic laxatives containing Mg to

Answer 41

those with renal insufficiency

Question 42

4 categories of constipation medications

Answer 42

fiber supplements stool softeners osmotic laxatives stimulant laxatives

Question 43

complications of constipation

Answer 43

hemorrhoids/anal fissures fluid and electrolyte abnormalities from laxative abuse fecal impacting and bowel obstruction (high risk in those with dementia, neurologic disease, immobile, hypomotility meds) disimpaction followed by maintenance bowel prep as appropriate

Question 44

symptoms of fecal impaction

Answer 44

N/V, abdominal pain, distention, paradoxical diarrhea

Question 45

what are some secondary/contributing causes of constipation

Answer 45

med-induced slow transit defecation/obstructive disorders metabolic/systemic dx

Question 46

most likely assoc with acute diarrhea

Answer 46

norovirus

Question 47

acute diarrhea length of time + definition of diarrhea

Answer 47

less than 14 days more than 3 unformed stools/day

Question 48

most common etiology of acute diarrhea

Answer 48

viral

Question 49

3 key history questions regarding acute diarrhea

Answer 49

prev colonoscopy red flag symptoms exposures

Question 50

red flags of diarrhea

Answer 50

fever unexplained weight loss melena, hematochezia persistent/progressive/nocturnal symptoms immunocompromised personal or FH of colon canccer, IBD, celiacs iron def anemia SIGNS OF VOLUME DEPLETION****

Question 51

exposures that can cause acute diarrhea

Answer 51

recent hospitalization or antibx use travel hx ingestion of improperly stored or prepared food sick contact exposure pets/animal exposure new meds or dose changes healthcare workers, daycare workers, food handlers

Question 52

inflammatory or noninflammatory: watery nonbloody diarrhea, nausea/vomiting mild diffuse abdominal cramps, bloating/flatulence +/- low grade fever

Answer 52

noninflammatory

Question 53

viral causes of acute noninflammatory diarrhea

Answer 53

norovirus

Question 54

protozoal cause of acute noninflammatory diarrhea

Answer 54

giardia

Question 55

inflammatory or noninflammatory acute diarrhea fever bloody diarrhea severe abdominal pain

Answer 55

inflammatory

Question 56

bacterial causes of inflammatory acute diarrhea

Answer 56

salmonella campylobacter shigella e. coli 0157:H7 c. diff

Question 57

what should we focus on with acute diarrhea

Answer 57

volume status and complications: look at vitals, skin turgor, mucus membranes, heart rate, abdominal stuff, rectal tenderness, stool guaiac, perianal disease, mental status

Question 58

normal pts with acute diarrhea dx

Answer 58

clinical

Question 59

what are signs that accompany acute diarrhea that require prompt evaluation

Answer 59

101.3F leukocytosis bloody diarrhea severe abdominal pain intractable vomiting watery diarrhea and dehydration AKI/lyte abnormalities elderly or nursing home residents immunocompromised hospital-acquired diarrhea

Question 60

acute diarrhea mgmt

Answer 60

supportive care and symptomatic relief oral rehydration tx lactose free diet probiotics imodium pepto-bismol

Question 61

do you need antibx for acute diarrhea

Answer 61

not usually - generally self limiting

Question 62

rice water diarrhea assoc with what

Answer 62

vibrio cholerae

Question 63

where do you pick up giardia lamblia

Answer 63

camping, lakes, streams, ponds, daycares, pools

Question 64

picked up from poultry and livestock, reptiles

Answer 64

salmonella

Question 65

what organism can be linked to guillain-barre syndrome

Answer 65

campylobacter jejuni

Question 66

classic dysentery AKA

Answer 66

shigella

Question 67

severe afebrile bloody diarrhea - what pathogen

Answer 67

E. Coli 0157:H7

Question 68

tx of E. Coli 0157:H7

Answer 68

no antidiarrheal no antibx DUE TO RISK OF HUS

Question 69

what bug has a risk of HUS

Answer 69

E. coli 0157:H7

Question 70

what bug is assoc with recent hospitalization/antibiotic use

Answer 70

c. diff

Question 71

tx of c.diff

Answer 71

vanco (DOFC) fidaxomicin metro

Question 72

what bug is assoc with raw seafood/shellfish

Answer 72

vibrio parahemolyticus

Question 73

what mimics appendicits and how

Answer 73

yersinia entercolitica (RLQ pain)