Irritable Bowel Syndrome Flashcards Preview

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Flashcards in Irritable Bowel Syndrome Deck (17):
1

Three Sub-Types of IBS

Diarrhoea predominant
Constipation predominant
Mixture between the two

2

Pathophysiology

genes + ENVIRONMENT
disturbed GI motility
Visceral hypersensitivity

3

Viceral Hypersensitivity

Seen in 2/3 of patients
Mechanisms =
Peripheral sensitisation
Central sensitisation

4

Rome III Criteria for IBS

Recurrent abdo pain/discomfort for at least 3 days per month for 3 months + 2 or more of:
Improvement with defecation
Change in stool frequency
Change in stool form (appearance)

5

Additional Symptoms

Bloating
Urgency
Sensation of incomplete emptying
Mucus per rectum
Nocturia (and poor sleep)
Aggravated by stress

6

Associated Illnesses

Fibromyalgia
Chronic fatigue syndrome
Temporomandibular joint dysfunction
Chronic pelvic pain

7

Psychological Features

Depression
Anxiety
Hypochondriacal

8

History

Bowel habit
Bloating, nocturia
Diet (bread, fibre, bizarre exclusions)
Trigger factors (infection, menstruation, drugs)
Opiate use
Psychosocial factors (stress)
Underlying fears ("cancer")

9

Red Flags

Age >50
Short duration of symptoms
Woken from sleep by altered bowel habit
Rectal bleeding
Weight loss
Anaemia
FH of colorectal cancer
Recent antibiotics

10

Investigations

FBC
ESR/plasma viscosity
CRP
Antibody testing for coeliac disease
Red flags = Lower GI investigations

11

Treatment - Diet

Regular meal times
Reduce fibre intake
Restrict tea and coffee intake
Reduce intake of "resistant starch"
If diarrhoea, avoid sorbitol
Persistent symptoms = consider single food avoidance and exclusion diets (e.g. low FODMAP diet)

12

Treatment - Drugs

Stop opiate analgesia
Anti-diarrhoeals
Anti-spasmodics
Anti-depressants

13

Laxatives

Lactulose promotes flatulence
PEG based are better as effect doesn't wear off

14

Anti-Diarrhoeals

Loperamide
Inhibits peristalsis, gut secretions
Benefits diarrhoea
Use PRN/prophylactically

15

Anti-Depressants

Tricyclics
Reduce diarrhoea
Reduce pain
Help restore sleeping pattern
Side effects =
Dry mouth
Fatigue
Solomance

16

Psychological Treatment

If severe anxiety/depression and no response to anti-depressants
Relaxation therapy
Cognitive behavioural therapy
Hypnosis

17

Simple Management Plan

Diet
Symptomatic Relief
Loperamide/movicol/anti-spasmodic
Amitriptyline