Week 9 Part 2

Question 1

What does itis generally mean?

Answer 1

Inflammation of the colon

Question 2

What is IBS?

Answer 2

Clinical diagnosis based on typical symptoms - ABC of symptoms

Question 3

1950

Answer 3

It was called nervous colitis

Definition has changed considerably over the years

Question 4

1960

Answer 4

Mucous colitis
Absence of objective biomarker
Symptom based diagnosis

Question 5

1970

Answer 5

Spastic colon

Question 6

1980

Answer 6

Irritable bowel syndrome

systematised by multi-national Rome comittee - 4th iteration

Question 7

What is the Manning criteria?

Answer 7

Abdominal pain was in someway associated with bowel movements

Pain relieved by defaecation

Question 8

What did Rome criteria suggest?

Answer 8

Recurrent abdominal pain on weekly basis

Change in frequency/form of stool

Question 9

What is the red flag symptoms?

Answer 9

Rectal bleeding
Weight loss
Recent antibiotic use
Nocturnal symptoms

Question 10

What are the criteria based diagnosis of IBS?

Answer 10

Symptoms present for more than 6 months
Frequent consultation for non-gastrointestinal symptoms
Previous medical unexplained symptoms
Patient reports that stress aggravates symptoms

Question 11

What are alarm feature in IBS?

Answer 11

Age > 50 years
Short history of symptoms 
Documented weight loss 
Nocturnal symptoms
Male sex 
Family history of colon cancer 
Anaemia 
Recital bleeding 
Recent antibiotic use

Question 12

What does IBS cover?

Answer 12

A lot of different symptoms

Question 13

IBS mixed

Answer 13

Float back and forth between diarrhoea and constipation

Question 14

IBS with constipation

Answer 14

> 25% hard stools

<25% loose stools

Question 15

IBS mixed

Answer 15

Both hard and loose stools

Question 16

IBS with diarrhoea

Answer 16

> 25% loose stools

< 25% hard stools

Question 17

Epidemiology of IBS in US and Europe

Answer 17

10-15%

Similar to South America

Question 18

Epidemiology in China of IBS?

Answer 18

23%

1 in 4 people to have IBS

Question 19

Gender difference in terms of IBS

Answer 19

3 females to 1 male in the UK/North America

Reflects the degree of cultural differences between groups

Question 20

What is the main predictor of IBS?

Answer 20

Abdominal pain

Question 21

How much percentage does IBS count for in all GP consultation?

Answer 21

3%

Question 22

What does predictors do?

Answer 22

Move patients from primary care to secondary care

Question 23

What are patients worried about?

Answer 23

Abdominal pain
Changes in bowel habits
cancer

Question 24

What makes IBS symptoms worse?

Answer 24

Stress

Question 25

What does predictors do?

Answer 25

Move patients from primary care to secondary care

Question 26

What are patients worried about?

Answer 26

Abdominal pain Changes in bowel habits cancer

Question 27

What makes IBS symptoms worse?

Answer 27

Stress

Question 28

Why is IBS a common disorder?

Answer 28

4 new patients of IBS every year

Question 29

What is presenteeism?

Answer 29

Working while sick - not doing anything productive Productivity loss Poor health Exhaustion and work place epidemics

Question 30

What is the cost of patients in the US?

Answer 30

Over 5000 dollars per annum

Question 31

What does SFI36 measure ?

Answer 31

Instrument used for evaluating health-related QoL

Question 32

What are the different aspects it measures?

Answer 32

``` Physical functioning Physical limitation Bodily pain Well being Emotional General health ```

Question 33

IBS

Answer 33

Costs a lot | Significant reduction in people’s quality of life

Question 34

What is the prevalence of IBS?

Answer 34

10-20%

Question 35

What are different components of abdominal pain?

Answer 35

Psychosocial abnormalities Motility abnormalities Sensory abnormalities CNS processing abnormalities

Question 36

What is the Brain Gut Axis?

Answer 36

Bi-directional communication system from gut to CNS

Question 37

What is the Enteric Nervous System?

Answer 37

Little Brian

Question 38

What is the Enteric Nervous System?

Answer 38

Little Brain | Brain in the GIT

Question 39

What is ENS composed of?

Answer 39

2 neuronal plexus | Sub-mucosal and mucosal plexi

Question 40

What does the 2 neuronal plexus control?

Answer 40

Motility Secretion Neurohormonal activation within the gut

Question 41

What are the 2 pathways that information goes back up to the brain?

Answer 41

Spinal pathways | Vagal pathways

Question 42

What is spinal pathways?

Answer 42

Roles in perception of the internal state | Pain and inhibition of digestive function

Question 43

What is vagal pathway?

Answer 43

Physiological sensation Hunger, satiety etc Reflex control Behaviour

Question 44

What are 3 main pathways of ascending?

Answer 44

Spinomesencephalic Spinoreticular Spinothalamic

Question 45

Geography of pain

Answer 45

Posterior Insula Thalamus Primary sensory area

Question 46

Emotional/affective component of pain

Answer 46

Pain makes us feel Amygdala, anterior Insula, ACC Pain forms memories

Question 47

Descending pathway

Answer 47

Largely mediated in ACC via periaacquctal grey in the medulla 3 separate pathsways after their neurotransmitters - Opiodergic, Noradrenergic and Serotonergic

Question 48

What does CNS exert influence on?

Answer 48

Motility Secretion Immune function

Question 49

What is the Brain gut axis vital for?

Answer 49

Regulation of food intake Digestion Sensation Control of motility

Question 50

What happens if there is any disruption at any level of brain gut axis?

Answer 50

Profound changes in perception in the internal state

Question 51

What is visceral hypersensitivity?

Answer 51

Changes in gut motility

Question 52

Why do patients with IBS get chronic abdominal pain?

Answer 52

Disturbance of brain gut axis at any level | Change from level of gut wall, spinal dorsal horn, spinal cord to anywhere in the CNS

Question 53

What is TRPV1 sensitive to?

Answer 53

Capsaicin

Question 54

What does all IBS patients have?

Answer 54

Elevated TRPV1 fibres in the rectum

Question 55

What is post-infectious IBS?

Answer 55

When IBS occurs after what appears to be a bout of gastroenteritis

Question 56

Post infectious IBS has been described following what infections?

Answer 56

Campylobacter Salmonella Shigella

Question 57

What are the risk factors for PI-IBS?

Answer 57

The duration and severity of initial illness Features in the infected person such as psychological factors m, gender and age The capability of bacteria to produce a toxin

Question 58

What are the physiological mechanisms in IBS?

Answer 58

``` Central nervous system Stress responsive systems Psychological factors Genetic factors Microbiota ```

Question 59

In IBS what is there a considerable overlap with?

Answer 59

Psychological disorders

Question 60

What are the functional neuroimaging techniques ?

Answer 60

Cortical evoked potentials (CEP) Magnetoencephalograpy (MEG) Position Emission Tomography Functional Magnetic Resonance Imaging

Question 61

Central Structural Abnormalities in IBS

Answer 61

Thinning in the anterior mid-cingulate and insular cortex in IBS

Question 62

What did meta-analysis of central structures show greater engagement with?

Answer 62

Emotional arousal | Endogenous pain modulation

Question 63

What are the major components of stress responsive system?

Answer 63

ANS HPA axis Link external environment with internal milieu

Question 64

What can psychological factors do?

Answer 64

Aggravate or induce symptoms

Question 65

What do IBS patients with history of abuse have?

Answer 65

Lower sensory thresholds Lower defaecatory urge thresholds Greater tendency to report pain

Question 66

What are the 3 phyla within human gut?

Answer 66

Firmicutes Bacteroidetes Actinobacteria