Irritable Bowel Syndrome

Question 1

def

Answer 1

functional bowel disorder defined as recurrent episodes (in the absence of detectable pathology) of abdominal pain/discomfort for >6 months of the previous year, associated with two of the following:
1 altered stool passage
2 abdominal bloating
3 symptoms worse after eating
4 passage of mucous

Question 2

aetiology

Answer 2

unknown

associated with
1 visceral sensory abnormalities
2 gut motility abnormalities
3 stress
4 food intolerance (lactose)

Question 3

epi

Answer 3

common
prevalence 10-20% of adults
females>males

Question 4

history

Answer 4

1 >6 months of abdominal pain
-relieved by defaecation/flatus
2 altered bowel frequency
->3 bowel motions daily
-<3 bowel motions weekly
3 abdominal bloating
4 'red flag' symptoms
-weight loss
-anaemia
-PR bleeding
->60yrs

Question 5

what must be excluded with symptoms of IBS

Answer 5

colonic malignancy

Question 6

examination

Answer 6

normally nothing

distended abdomen and mild tenderness in RIF/LIF

Question 7

investigations

Answer 7

diagnosis mainly from history, investigations for exclusion
1 bloods
-anti-endomysial or anti-transglutaminase antibodies (to exclude coeliacs)
2 stool examination
-microscopy + culture to exclude infection
3 USS
-to exclude gallstones
4 hydrogen breath test
-to exclude H. pylori
5 endoscopy
-for exclusion of malignancy

Question 8

management

Answer 8

1 advice
-diet (reduce insoluble fibre) for constipation
2 medical for treatment of symptoms
-antispasmodics (mebeverin, buscopan)
-prokinetic agents (domperidone, metoclopramide)
-antidiarrhoeals (loperamide)
-laxatives (lactulose)
3 psychological therapies
-CBT, relaxation, for stress

Question 9

complications

Answer 9

increased incidence of colonic diverticulosis

Question 10

prognosis

Answer 10

chronic relapsing

often exacerbated by stress