Other Intestinal Disorders

Question 1

What is IBS?

Answer 1

Recurrent abdominal discomfort or pain, chronic for > 3 months, occurring on average at least one day per week; and has two of the three:

1. Related to defecation
2. Association with change in frequency of stool
3. Association with change in consistency of stool

Question 2

Is there an anatomical cause that can be found on labs, XRays, or biopsies in IBS?

Answer 2

No

Question 3

What are the physiologic factors of IBS?

Answer 3

• Altered intestinal motility
• Increased intestinal sensitivity (visceral hyperalgesia)
• Various genetic and environmental factors
• Hormonal fluctuations (women)
• Psychosocial factors

Question 4

Rectal insensitivity can be associated with what physiologic time in women?

Answer 4

Menses

Question 5

When is the typical onset of IBS?

Answer 5

Begins in adolescence/20’s

Question 6

What are the common symptoms associated with IBS?

Answer 6

• Abdominal discomfort
• Discomfort related to defecation; often sx resolve after defecation
• Cramping

Question 7

Do bouts of IBS typically rouse patient from sleep?

Answer 7

No

Question 8

What does a DRE test for?

Answer 8

Occult blood in the stool

Question 9

What is FODMAP?

Answer 9

Diet that exclude diarrhea-producing foods

Question 10

When treating constipation with fiber supplementation what is critically important for the patient?

Answer 10

Hydration

Question 11

What are some diet modifications in the treatment of IBS?

Answer 11

• Small meals, eating slowly
• Reduce beans, cabbage, and other fermentable foods
• Reduce sweeteners
• Low fat diet
• Hydration
• Dietary fiber supplements

Question 12

What are the three medications that can be used to treated IBS-C?

Answer 12

• Lubiprostone
• Linaclotide
• Plecanatide

Question 13

What are the medications that can be used to treat IBS-D?

Answer 13

• Diphenoxylate or Loperamide
• Rifaximin
• Alosetron
• Elexadoline (need special license to prescribe)

Question 14

What is the drug name for Miralax?

Answer 14

Polyethylene glycol laxative

Question 15

What symptom of IBS can probiotics be helpful in alleviating?

Answer 15

Bloating

Question 16

What are the symptoms associated with lactose intolerance?

Answer 16

Diarrhea
Abdominal distention
Flatulence

Question 17

What is the most common type of lactose intolerance?

Answer 17

Acquired lactose deficiency

Question 18

What is the clinical presentation of lactose intolerance in children?

Answer 18

Diarrhea after ingesting a significant amount of milk; not gaining weight

Question 19

What is the clinical presentation of lactose intolerance in adult?

Answer 19

Watery diarrhea, bloating, excessive flatus, nausea, borborygmi, abdominal cramps after ingesting lactose

Question 20

What is the preferred test for diagnosing lactose intolerance?

Answer 20

Hydrogen breath test (but doesn’t have to be completed if high clinical suspicion)

Question 21

What is the treatment for lactose intolerance?

Answer 21

Avoid dietary sugars
Enzyme supplements

Question 22

What supplement should patients with lactose intolerance take?

Answer 22

Calcium

Question 23

What is non-ulcer dyspepsia?

Answer 23

Dyspeptic symptoms with no abnormalities on PE and EGD and/or other evaluation

Question 24

Alternating constipation and diarrhea with dyspepsia suggests what two possible etiologies?

Answer 24

IBS or Excessive use of OTC

Question 25

What are ulcer-like symptoms?

Answer 25

Pain localized in epigastrium, occurs before meals, partially relieved by food, antacids, or H2 blockers

Question 26

What bacteria causes non-ulcerative dyspepsia and can increase risk of cancer?

Answer 26

H. pylori

Question 27

What is the treatment for non-ulcer dyspepsia?

Answer 27

Treat specific symptoms *symptoms can be treated with PPI's, H2 blockers, or cytoprotective agent

Question 28

What is the role of treatment with TCA's in non-ulcer dyspepsia?

Answer 28

Alter sensory perception

Question 29

Is acute constipation more suggestive of an organic or functional cause?

Answer 29

Organic

Question 30

Excessive straining may contribute to anorectal pathology which may include

Answer 30

Hemorrhoids Anal fissure Rectal prolapse Syncope

Question 31

What is the normal transit time of food to pass through the entire GI system?

Answer 31

35 hours

Question 32

What is the treatment for constipation?

Answer 32

Trial of fiber and/or over the counter laxatives

Question 33

If trial of treatment fails in constipation what is the next step?

Answer 33

Measure colonic transit times with radiopaque markers (Sitz markers)

Question 34

What patient cohorts is laxative abuse more likely?

Answer 34

- Eating disorders - Elderly who continue treatment after constipation ceased

Question 35

When prescribing opioids what should be co-prescribed to be started at the same time?

Answer 35

Laxatives

Question 36

What is the etiology of opioid induced constipation?

Answer 36

Opioids inhibit gastric emptying and peristalsis in GI tract, delays absorption of meds and increased absorption of fluid

Question 37

What are the prescribed pharmacologic treatments for OIC?

Answer 37

- Methylnaltrexone bromide (Relistor) - Lubiprostone (Amitiza)