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Flashcards in IBS Diarrhea Deck (30):
1

IBS

MC in females 18-34
MC GI diagnosis

2

IBS: pathophysiology

1. Abnormal GI motility
2. Visceral hypersensitivity
3. Psychopathology

3

Rome IV criteria

-recurrent ABD pain
-at least 1 day a week
-During last 3 months

4

IBS history

some patients repost acute viral or bacterial gastroenteritis prior to onset of IBS

5

IBS: PE

pretty normal, possibly tenderness

6

If patient presents with IBS symptoms, what labs do you order

1. CBC
2. Celiac
3. CRP, if diarrhea

7

Alarm features of IBS

>50 years
Rectal bleeding or melena
Nocturnal diarrhea
Progressive abdominal pain
Unexplained weight loss
Abnormal labs: CBC, CMP, H/H
Recent antibiotics
Recent travel

8

If patient with IBS has rectal bleeding what test is indicated?

flex sigmoid/colonoscopy

9

If patient is 45 and has IBS symptoms what is the best test?

colonoscopy

10

What is the most important Tx for IBS?

Establish positive clinician-patient relationship

2. Lifestyle and diet modification

11

IBS-C: treatment

1st line: psyllium fiber
2nd line: MIralax (osmotic laxatives)

12

IBS-D: treatment

1st line: antidiarrheal agents - Ex. Loperamide before meals

2nd line: cholestyramine (bile acid sequestrant - post cholecystectomy)

13

IBS, severe symptoms, refractory

1. Antidepressants (ex. TCAs for IBS-D)

2. SSRI (ex. Zoloft) in IBS- C since this causes diarrhea

14

What is the difference between constipation and IBS-C

IBS-C has pain

15

Rome IV: constipation

-symptoms for 3 months
-symptoms started in last 6 months

16

Constipation: PE

1. Anal wink
2. DRE
3. Pelvic exam - evaluated for pelvic floor dysfunction

17

Constipation: labs

-CBC
-CMP
-Thyroid

18

What is the initial therapy for constipation?

trial of fiber supplementation

refractory cases: colonic transit study, anorectal manometry

19

Constipation management pearl

Minimize laxative use

20

Who must you be careful about using milk of magnesia in?

renal failure patient

21

Diarrhea duration

Acute: <2 weeks (14 days)

Persistent: 2-4 weeks

Chronic: >1 month

22

Acute diarrhea

MC viral (ex. Rotavirus, adenovirus, Norwalk-like virus)

-bacterial more severe

23

Acute diarrhea: noninflammatory versus inflammatory

non inflammatory: watery (ex. Giardia)
-abdominal cramping
-nausea/vomiting


inflammatory: bloody diarrhea (ex. salmonella, shigella, C diff, campylobacter)
-fever, tenesmus**

24

MCC of bloody diarrhea

enterohemorrhagic E. coli

-NO FEVER**, bloody stool, abd tenderness

25

Microbiologic testing for acute diarrhea will identify which organisms?

Shigella
Salmonella
Campylobacter
Enterotoxigenic E. coli

26

If you suspect EHEC what other tests must be ordered?

1. Culture for E. coli O157:H7
2. Shiga toxin

27

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

28

Who should you avoid Loperamide in?

-suspected inflammatory diarrhea

-Fever

-Pediatric patients

29

When should you consider antibiotics for diarrhea?

-immunocompromised
-moderate to severe diarrhea that EHEC and Cdiff are not suspected
->6 unformed stools a day
-Symptoms for > 1 week

30

What antibiotic is preferred for diarrhea?

Ciprofloxacin for 3-5 days

DON'T use ABO if bloody diarrhea