IBS, Constipation, Diarrhea Flashcards
What is the Rome IV criteria for IBS?
Recurrent abd pain
≥ 1day/wk
During last 3 months
A/w ≥ 2 of the following - defecation, change in stool frequency, change in stool form
What are the 4 subtypes of IBS?
IBS w/ constipation
IBS w/ diarrhea
IBS w/ mixed bowel habits
IBS unclassified
What condition can present exactly like IBS? How do you rule this out?
Celiac!
IgA TTG or celiac panel
What labs should be used for dx of IBS?
It is a dx of exclusion
Get CBC, celiac, CRP
What imaging can be use to look for stool accumulation & severity in IBS w/ constipation?
Abd radiograph
What red flags indicate the pt has something other than IBS?
Age > 50 Rectal bleeding or melena Progressive abd pain Wt loss Lab abnormalities Fam hx of IBD or colon CA Recent abx or travel
How should you treat IBS in pts w/ mild & intermittent sx?
Lifestyle & diet modification
How should you treat severe IBS-C?
- Osmotic laxatives (PEG/Miralax)
- Lubiprostone (women 18+)
Consider SSRIs (zoloft)
How do you treat severe IBS-D?
Antidiarrheal (Loperamide 45 mins before a meal)
Bile acid sequestrants (cholestyramine)
Consider TCAs (low dose)
How do you manage abd pain & bloating in IBS?
Antispasmodics (dicyclomine, hyoscyamine)
What are ADEs of PEG/miralax?
Bloating/abd discomfort
What is an ADE of lubiprostone?
Nausea
What should your differential consist of in regards to constipation?
Colon CA Hypothyroidism DM Parkinsons, SC lesion Proctitis Obstruction
What is the Rome IV criteria for constipation?
2 or more of the following for ≥ 3 months:
- Straining > 25%
- Lumpy or hard stools > 25%
- Sensation of incomplete evacuation > 25%
- Sensation of anorectal blockage > 25%
- Manual maneuvers to facilitate defecation > 25%
- < 3 BMs/wk
What are the 3 main causes of constipation?
Slow-transit
Pelvic floor dysfunction
Meds
Constipation: What should your PE consist of?
Anal reflex: anal wink
DRE
Evaluate for rectocele
What labs should you order for constipation?
CBC, CMP, thyroid
What procedure should be performed for high risk pts w/ constipation?
Colonoscopy or flex sig/BE
In refractory pts, what additional tests are available?
Colonic transit study
Anorectal manometry
What types of laxatives can be used for tx of constipation?
Osmotic (Miralax)
Saline (Milk of mag)
Emollient (Colace)
Stimulant (Senokot)
Stimulant + emollient (Peri-colace)
What are complications of constipation?
Fecal impaction –> large bowel obstruction
What are the 3 subtypes of diarrhea?
Acute: ≤ 14 days duration
Persistent: 14-30 days
Chronic: > 30 days
What causes acute diarrhea?
MC = rotavirus, adenovirus, norwalk-like virus
Bacterial: campylobacter, salmonella, shigella
Protozoa: crytosporidium, giardia
What is the main differential for acute diarrhea?
Fecal impaction
