IBS + constipation Flashcards
What causes IBS [3]
Unknown cause related to gut sensitivity and altered motility
No inflammation or damage to bowel
Functional (thought to be due to disorders of intestinal motility or enhanced visceral perception)
What brings IBS on [6]
Stress Anxiety Depression Emotional distress Menstruation Gastroenteritis
What sxs are part of diagnostic criteria for IBS
Abdominal pain +2 of Relief by defecation Altered frequency Altered form - C or D >6 months
and >2 of: Urgency / straining Incomplete evacuation Bloating Worse after eating Mucous / bleeding in stool
What is characteristic of IBS abdominal pain [5]
Radiate to back Vague Burning Rare at night Non-cyclical (endometriosis can mimic)
What are other features [4]
Lethargy
Nausea
Backache
Bladder issues
What investigations do you perform in IBS [3]
Bloods: FBC, ESR, CRP, LFT, coeliac serology, CA-125 if female
Stool: culture if diarrhoea prominent, faecal calprotectin
Colonoscopy if 60+ / alarm symptoms
Refer if FH ovarian / bowel
What is calproctectin
Marker of inflammation in mucosa - Differentiates IBD and IBS
How do you treat IBS non-pharmacological [4]
Dietic review - FODMAP, lactose, gluten
Exercise
Reduce stress
Psychotherapy if refractory >12 months
How do you treat pain in IBS [2]
Anti-spasmodics
Antidepressants - TCA 2nd line or SSRI (also if refractory)
How do you treat bloating [2]
Probiotics
Avoid fibre and bulking agents
How do you treat constipation [4]
Laxatives
Avoid FODMAP
5HT4
Water + fibre
How do you treat diarrhoea [4]
Anti-motility agent
FODMAP
Loperamide = 1stline
Avoid caffeine / alcohol
What are alarm symptoms in IBS requiring colonoscopy [9]
50+, Male Short history <6 months Waking at night with pain/diarrhea Weight loss FH Bowel / ovarian ca Abnormal CRP, ESR, Low Hb Rectal bleeding Mouth ulcers Abdominal mass Recent antibiotic use as decreased diversity
What drugs cause constipation [5]
Opiates Anti-cholinergic Iron Diuretic CCB
What are neurogenic causes of constipation [6]
Neuropathy Parkinson's Stroke MS Spinal cord injury Systemic sclerosis
What are organic causes [8]
Strictures Malignancy Diverticulitis IBD Fissure Prolapse Obstruction, Psuedo-obstruction after operation Gastrostasis due to DM Congenital: Hirschsprung
What are systemic causes of constipation [4]
Diabetes
Low thyroid
Hyper-calcium
Hypokalaemia
What are functional causes of constipation [5]
Mega-colon Depression Psychosis Pain No toilet
What are other causes of constipation [6]
Lack of fibre Lack of exercise Unhealthy BMI Dehydrated Age Hospital / post-op
How do you Dx constipation [4]
DRE (impaction, rectal tumor)
Abdo exam (mass, tenderness)
FBC, ESR, U+E, Ca, TFT
Colonoscopy if suspected malignancy
How do you treat constipation [6]
Lifestyle advice - drink more, high fibre
Diet advice
Bulking agent e.g. fibrogel
Oral laxative
Suppository
Phosphate Enema - useful if impacted before use laxative
What are complications of constipation [5]
Haemorrhoids Faecal impaction Bowel incontinence / overflow Acute urinary retention Delirium
What is 1st line laxative
Stimulant e.g. senna to increase motility
What is 2nd line
Senna + laxido
