Flashcards in Wk 6 Deck (13)
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1
3 key ssx of IBS
abd pain
change in frequency of stool
change in consistency of stool
2
Rome II criteria
in the past yr, at least 12 weeks (not necessarily consecutive) of abd pain/discomfort w 2 out of the following 3:
1. relieved w defecaton
2. onset assoc w change in freq of stool
3. onset assoc w change in form of stool
3
how does the menstrual cycle and post-menopausal status affect IBS symptoms?
-IBS most prevalent during menstruation years. More common in F than M
-sxs most severe: postovulatory/premenstrual (mb due to incr progesterone levels)
-abd bloating after menopause
4
what stool tests may reveal infectious etiologies for IBS?
fecal WBCs, O&P, culture
(PI-IBS bugs: campylobacter, salmonella, shigella, e.coli, viruses, giardia)
CDT (cytolethal distending toxin) destroys pacemaker cells (interstitial cells of Cajal) of the MMC
Vinculin looks like CDT so our body make autoantibodies (anti-vinculin antibodies)
5
what are the red flags in IBS?
symptom onset after age 50
severe, unrelenting diarrhea
nocturnal sx
unintentional WT loss
hematochezia
FHx of colorectal CA
6
What non-invasive tests are used to determine the need for colonoscopy to rule out more serious diagnoses in patients with IBS-like sx?
hydrogen/methane breath testing to dx SIBO
blood tests: CBC, ESR, CV, KD, thyroid
7
What are seven clinical indicators that increase the chances of SIBO being the etiology for IBS?
-pt develops IBS after acute gastroenteritis (PI IBS)
-after Abx tx, sxs dramatically improve
-after probiotics, sxs are worse
-eating more fiber incr constipation and other sxs
-when a "celiac pt" sxs do not improve after GF diet
-after taking opiates, pt develops IBS-C (C= constipation)
-pt has chronic low ferritin level w no apparent cause
-imaging reveals large gas bubble obscuring the pancreas
-small bowel follow-through imaging reveals areas of "flocculation"
8
physiological mechanisms by which bacterial overgrowth is normally prevented?
-stomach acid, pancreatic enzymes, bile in the duodenum
-ph >3...overgrowth in ST and SI likely
-a well functioning ileocecal valve
-SI motility via MMC
-normal glycocalyx and microvillus of brush border
9
what are the effects of H2 and CH4 on gastrointestinal motility?
methane: constipation alone, or alternating constipation and diarrhea. slow GI motility
hydrogen: diarrhea. usu IBS-D (diarrhea type). Increases GI motility
10
which gas produced by SIBO is assoc w incr sx of fibromylagia?
hydrogen
11
what is the likely mechanism by which SIBO leads to fat soluble vit def?
-damage to SI (digestive and absorptive function)
-bugs make glycosidase which damages glycoclyx or disaccharidases (deconjugation of bile-->fat malabs, steatorrhea, fat solube vit def)
12
what are the four main categories of treatment for SIBO?
-diet (SCD, low-FODMAPS, elemental diet)
-herbal Abx (FC-Cidal w Dysbiocide OR Candibactin-AR w Candibactin-BR) (garlic, oregano, neem, berberine)
-antibiotics (Rifaximin for H2, Rifaximin + Neomycin for CH4)
-prokinetics (LDE, LDN, prucalopride, can add biofilm disruptor like NAC)
13
