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Clin Med III > IBS > Flashcards

IBS Flashcards

1
Q

Is iron def anemia assoc with IBS

A

no

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2
Q

Is weight loss assoc with IBS

A

no

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3
Q

IBS: _______ bowel disorder characterized by what?

A

function

recurrent abdominal pain AND altered bowel habits

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4
Q

4 subclassifications of IBS

A

Constipation predom

Diarrhea predom

Mixed

Unclassified

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5
Q

ages IBS affects

A

20-39

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6
Q

M or F predominance with IBS

A

F

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7
Q

Average time to dx IBS

A

about 4 yrs

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8
Q

etiology of IBS

A

physiological

psychosocial

environmental

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9
Q

2 physiological reasons for IBS

A

abnormal motility

visceral hypersensitivity

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10
Q

psychosocial reasons for IBS

A

early life stressors (like abuse)

anxiety, depression, phobias

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11
Q

environmental reasons for IBS

A

diet, post-infectious, gut microbiome

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12
Q

two components needed for IBS

A

** chronic/recurrent abdominal pain/discomfort

** altered bowel habits (constipation/diarrhea)

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13
Q

when does diarrhea happen with IBS

A

in AM and post-prandially

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14
Q

IBS clinical presentation

A

chronic/recurrent abdominal pain and discomfort

altered bowel habits

+/- dyspepsia, atypical CP, vomiting

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15
Q

extra-intestinal symptoms assoc with IBS

A

sexual dysfunction

dysmenorrhea

irritative voiding symptoms

fibromyalgia

somatic or psyc complaints

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16
Q

alarm features of IBS

A

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

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17
Q

IBS physical exam

A

usually normal

tenderness upon palpation on abdominal exam

do perianal and DRE

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18
Q

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

A

Rome IV

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19
Q

Rome IV criteria (what is it?)

A

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)

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20
Q

IBS dx: typical hx and no alarm features

A

lab, radiographic, endoscopic tests not routinely recommended

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21
Q

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

A

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

cross-sectional/small bowel imaging

endoscopy/colonoscopy with biopsies

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22
Q

goal of IBS tx

A

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

dietary/lifestyle measures

psychosocial support

pharm therapy

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23
Q

some dietary/lifestyle measures

A

food diary/symptomatology

dietary fiber (20-35 g/day)

FODMAP diet

Probiotics

Exercise

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24
Q

IBS psychosocial support

A

CBT

Relaxation/stress mgmt

behavioral health referral

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25
Q

abdominal pain IBS meds

group of side effects

A

levsin

bentyl

**anticholinergic effects

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26
Q

IBS-C medications

A

fiber

miralax

amitiza

linzess

trulance

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27
Q

IBS-D meds

A

imodium

rifaximin

viberzi

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28
Q

psychosocial IBS meds

A

TCAs (off label)

  • crazy side effects
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29
Q

3 classes of meds that make constipation worse

A

antipsychotics

iron

opioids

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30
Q

most common digestive complaint in gen pop

A

constipation

31
Q

males or females complain of constipation more

A

females

32
Q

4 risk factors of constipation

A

improper diet and inadequate fluid intake

sedentary lifestyle

polypharm

increased age

33
Q

6 etiology categories of constipation

A

functional

med-induced

slow transit

defecation/obstruction

metabolic/systemic disease

other

34
Q

key history questions for constipation

A

laxatives?

need for digital evacuation?

previous colonoscopy

red flag symptoms/alarm features

reconcile meds/review PMH if needed for secondary/contributing causes of constipation

35
Q

dx criteria for constipation

A

25% of defecations are:

less than 3 spontaneous BM/week

lumpy or hard stools

straining

manual maneuvers

anorectal obstruction sensation

incomplete evacuation

36
Q

common GI symptoms assoc with constipation

A

abdominal pain and bloating

pain on defecation

rectal bleeding

tenesmus (anal quivering)

37
Q

red flag symptoms in constipation

A

acute onset

50+

fevers/vomiting

weight loss

melena/hematochezia

personal or FH of colon cancer, IBD, celiac’s

iron def anemia

38
Q

what should you do for refractory pts with constipation

A

colonic transit (radiopaque marker)

defecography

anorectal manometry

39
Q

adverse effects of fiber

A

flatulence, bloating, distention

40
Q

adverse effects of osmotic laxatives

A

GI discomfort, bloating

41
Q

who should you NOT give osmotic laxatives containing Mg to

A

those with renal insufficiency

42
Q

4 categories of constipation medications

A

fiber supplements

stool softeners

osmotic laxatives

stimulant laxatives

43
Q

complications of constipation

A

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

44
Q

symptoms of fecal impaction

A

N/V, abdominal pain, distention, paradoxical diarrhea

45
Q

what are some secondary/contributing causes of constipation

A

med-induced

slow transit

defecation/obstructive disorders

metabolic/systemic dx

46
Q

most likely assoc with acute diarrhea

A

norovirus

47
Q

acute diarrhea length of time + definition of diarrhea

A

less than 14 days

more than 3 unformed stools/day

48
Q

most common etiology of acute diarrhea

A

viral

49
Q

3 key history questions regarding acute diarrhea

A

prev colonoscopy

red flag symptoms

exposures

50
Q

red flags of diarrhea

A

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**

51
Q

exposures that can cause acute diarrhea

A

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

52
Q

inflammatory or noninflammatory:

watery nonbloody diarrhea, nausea/vomiting

mild diffuse abdominal cramps, bloating/flatulence

+/- low grade fever

A

noninflammatory

53
Q

viral causes of acute noninflammatory diarrhea

A

norovirus

54
Q

protozoal cause of acute noninflammatory diarrhea

A

giardia

55
Q

inflammatory or noninflammatory acute diarrhea

fever

bloody diarrhea

severe abdominal pain

A

inflammatory

56
Q

bacterial causes of inflammatory acute diarrhea

A

salmonella

campylobacter

shigella

e. coli 0157:H7
c. diff

57
Q

what should we focus on with acute diarrhea

A

volume status and complications:

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

58
Q

normal pts with acute diarrhea dx

A

clinical

59
Q

what are signs that accompany acute diarrhea that require prompt evaluation

A

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

60
Q

acute diarrhea mgmt

A

supportive care and symptomatic relief

oral rehydration tx

lactose free diet

probiotics

imodium

pepto-bismol

61
Q

do you need antibx for acute diarrhea

A

not usually - generally self limiting

62
Q

rice water diarrhea assoc with what

A

vibrio cholerae

63
Q

where do you pick up giardia lamblia

A

camping, lakes, streams, ponds, daycares, pools

64
Q

picked up from poultry and livestock, reptiles

A

salmonella

65
Q

what organism can be linked to guillain-barre syndrome

A

campylobacter jejuni

66
Q

classic dysentery AKA

A

shigella

67
Q

severe afebrile bloody diarrhea - what pathogen

A

E. Coli 0157:H7

68
Q

tx of E. Coli 0157:H7

A

no antidiarrheal

no antibx DUE TO RISK OF HUS

69
Q

what bug has a risk of HUS

A

E. coli 0157:H7

70
Q

what bug is assoc with recent hospitalization/antibiotic use

A

c. diff

71
Q

tx of c.diff

A

vanco (DOFC)

fidaxomicin

metro

72
Q

what bug is assoc with raw seafood/shellfish

A

vibrio parahemolyticus

73
Q

what mimics appendicits and how

A

yersinia entercolitica (RLQ pain)

Clin Med III (6 decks)

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