scott IBS

Question 1

disease

Answer 1

a particular distinctive process in the body with a specific cause and characteristic symptoms

Question 1

syndrome

Answer 1

a number of symptoms occurring together and characterizing a specific disease

Question 2

disorder

Answer 2

irregularity, disturbance, or interuptions of normal functions

Question 3

IBS

Answer 3

characterized by abdominal pain or cramping and changes in bowel function
most common diagnosed GI disorder

Question 4

IBS DOES NOT cause

Answer 4

inflammation
changes in bowel tissue
increase risk of colorectal cancer

Question 5

Predisposing factors

Answer 5

female 2:1 (women>men)
lower socioeconomic status
age <50 years at time of diagnosis

Question 6

what is abdominal pain associate with?

Answer 6

abnormal bowel movements

Question 7

IBS can be

Answer 7

constipation-predominant or diarrhea predominant or alternate b/w the two

Question 8

thought to be due to somatovisceral and motor dysfunction of intestine

Answer 8

visceral hypersensitivity (pain) independent of motility and psychological disturbance

Question 9

majority of serotonin receptors in enteric nervous system

Answer 9

5-HT3 and 5-HT4 receptors are responsible for secretion, sensitization and motility

Question 10

IBS-C

Answer 10

CONSTIPATION DOMINANT
<3 stools/week, straining, incomplete evacuation

Question 11

IBS-U

Answer 11

undefined

Question 12

IBS-M

Answer 12

Mixed symptoms

Question 13

IBS-D

Answer 13

diarrhea predominant
>3 stools/day

Question 14

Non Gi sx

Answer 14

urinary sx
lower back pain
fatigue
dyspareunia

Question 15

common co-morbid conditions

Answer 15

fibrolyalgia
functional dyspensia
chronic fatigue syndrome

Question 16

diagnosis that must have >2 of the following

Answer 16

increase i pain related to defacation
assosciated with change in frequency of stool
associated with change in appearance of stool
symptoms onset should occur at least 6 motnhs prior to diagnosis

Question 17

diagnosis

Answer 17

no biomarker of disease are known
celiac disease screening indicated for IBS-D and IBS-M
lactose breath test can be considered if lactose intolerance is suspected
Colonoscopy, imaging and other testing is not indicated in absence of alarm features

Question 18

alarming features

Answer 18

rectal bleeding
weight loss
iron deficient anemia
nocturnal sx
family histpry of colorectal cancer, IBD or celiac disease
onset at age >50 years

Question 19

tx of IBS

Answer 19

60_70% feel food sensitivity impacts IBS sx
AVOID FOODS THAT MAKE SX WORSE!!

Question 20

low FODMAP diet

Answer 20

fermentable oligosaccharides, disaccharides, monosaccarides and polyols make it worse
small RCT showed sx imporvement in pts on low FODMAP compared to general diet
ADA recommends 20-35 g of fiber daily, 32-128 fluid ounces of water, regular aerbic exercise, and avoid postponing defecation.

Question 21

physical activity

Answer 21

NON PHARM MANAGEMENT
single RCT found that STRUCTURED PHSYCIAL ACITIVTY improved IBS symptoms compared to usual care

Question 22

cognitive behavrioal therapy

Answer 22

non pharm management
hypnotherapy
cut is telling brain to contract so working with that pathway

Question 23

tx for IBS-C predominant

Answer 23

1. increase fiber and fluid intake 2. add bulk-forming laxative 3. consider adding anti-spamodic or anticholinergic agent for GI symptoms 4. consider lubiprostone or linaclotide for tx of constipation and abdonminal pain 5. psychotherapeutic behavior modification, consider antidepressants 6. consider serotonin-4 agonist as last line

Question 24

hyoscyamine

Answer 24

antispasomodic anti-cholinergic

Question 25

dicyclomine

Answer 25

antispasmodic blocks ACH action on parasympathetic receptors on smooth muscle improve ab pain

Question 26

antidepressants- SSRI

Answer 26

citalopram lexapro prozac fluvoxamine paroxetine setraline

Question 27

Tegasero

Answer 27

5-HT4 agonist stimulated perisalisis and GI secretions modulates visceral sensitivity

Question 28

tx of IBS-D

Answer 28

manage stress + patient education diet: lactose free and caffeine free avoid foods that increase symptoms

Question 29

step by step tx of IBS-D

Answer 29

1. dietary modifications 2. add loperamide or anti0spasmodic agent (dicyclomine) 2a. replace with eluxadoline is pain persists 2b. consider rifaximin 3. add serotonin-3 antagonist (alosetron) 4. psychotherapeutic havhior modification, consider SSRI

Question 30

medications for IBS-D

Answer 30

loperamide (no effect on ab pain) diphenoxylate-atropine ( max 20 mg)

Question 31

eluxadoline

Answer 31

opioid receptor agonist contraindicated in patients with history of pancreatitis, alcoholism CIV due to euphoric feeling

Question 32

rifaximin

Answer 32

antiobotic agent for IBS-D

Question 33

peppermint oil

Answer 33

natural product for IBS-D

Question 34

antidepressant agents FOR ibs-d

Answer 34

notriptyline (best for IBS-D) amitryptyline trimipramine desipramine

Question 35

SUMMARY

Answer 35

IBS pathophysiology involves: host factors luminal factors environmental factors Diagnosis of IBS is based on frequency and characteristics of sx Tx approach is based on IBS subtype tx opt