Flashcards in IBS Diarrhea Deck (30):
MC in females 18-34
MC GI diagnosis
1. Abnormal GI motility
2. Visceral hypersensitivity
Rome IV criteria
-recurrent ABD pain
-at least 1 day a week
-During last 3 months
some patients repost acute viral or bacterial gastroenteritis prior to onset of IBS
pretty normal, possibly tenderness
If patient presents with IBS symptoms, what labs do you order
3. CRP, if diarrhea
Alarm features of IBS
Rectal bleeding or melena
Progressive abdominal pain
Unexplained weight loss
Abnormal labs: CBC, CMP, H/H
If patient with IBS has rectal bleeding what test is indicated?
If patient is 45 and has IBS symptoms what is the best test?
What is the most important Tx for IBS?
Establish positive clinician-patient relationship
2. Lifestyle and diet modification
1st line: psyllium fiber
2nd line: MIralax (osmotic laxatives)
1st line: antidiarrheal agents - Ex. Loperamide before meals
2nd line: cholestyramine (bile acid sequestrant - post cholecystectomy)
IBS, severe symptoms, refractory
1. Antidepressants (ex. TCAs for IBS-D)
2. SSRI (ex. Zoloft) in IBS- C since this causes diarrhea
What is the difference between constipation and IBS-C
IBS-C has pain
Rome IV: constipation
-symptoms for 3 months
-symptoms started in last 6 months
1. Anal wink
3. Pelvic exam - evaluated for pelvic floor dysfunction
What is the initial therapy for constipation?
trial of fiber supplementation
refractory cases: colonic transit study, anorectal manometry
Constipation management pearl
Minimize laxative use
Who must you be careful about using milk of magnesia in?
renal failure patient
Acute: <2 weeks (14 days)
Persistent: 2-4 weeks
Chronic: >1 month
MC viral (ex. Rotavirus, adenovirus, Norwalk-like virus)
-bacterial more severe
Acute diarrhea: noninflammatory versus inflammatory
non inflammatory: watery (ex. Giardia)
inflammatory: bloody diarrhea (ex. salmonella, shigella, C diff, campylobacter)
MCC of bloody diarrhea
enterohemorrhagic E. coli
-NO FEVER**, bloody stool, abd tenderness
Microbiologic testing for acute diarrhea will identify which organisms?
Enterotoxigenic E. coli
If you suspect EHEC what other tests must be ordered?
1. Culture for E. coli O157:H7
2. Shiga toxin
If patient has acute inflammatory diarrhea what tests should you consider?
1. Stool for blood and WBCs (or lactoferrin)
2. Routine stool culture
3. Stool culture for E. coli 157:H7 and stool for Shiga toxin
Who should you avoid Loperamide in?
-suspected inflammatory diarrhea
When should you consider antibiotics for diarrhea?
-moderate to severe diarrhea that EHEC and Cdiff are not suspected
->6 unformed stools a day
-Symptoms for > 1 week