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Pharmacy > 301 IBS > Flashcards

301 IBS Flashcards

1
Q

Does IBS pose threat to physical health?

A

No, does not increase chances of developing cancer or other bowel-related conditions

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2
Q

What can IBS follow?

A

Bout of gastroenteritis

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3
Q

IBS symptoms

A

Abdominal pain & cramping, change in bowel habits (diarrhoea), bloating & stomach swelling, flatulence, urgency to move bowels

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4
Q

Less common IBS symptoms

A

Lethargy, feeling sick, heartburn

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5
Q

When should you see a GP with suspected IBS?

A

Have IBS symptoms so can identify cause
Feeling anxious/change in mood as symptoms can worsen with stress

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6
Q

When should you urgently see a GP with suspected IBS?

A

Change in bowel habits >6 weeks especially 50+
Unexplained weight loss
Swelling/lump in stomach/back passage
Bleeding from back passage
Tell GP if Hx of bowel or ovarian cancer

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7
Q

Diagnosing IBS

A

No diagnosis but rule out coeliac or IBD
Blood tests and stool tests

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8
Q

Clinical features of IBS

A

Change in stool form/frequency
Leads to defaecation and associated bloating

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9
Q

What is IBS?

A

Abnormal smooth muscle activity
+/- visceral hypersensitivity
Abnormal central processing of painful stimuli

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10
Q

Possible mechanisms of IBS

A
  1. Visceral hypersensitivity
  2. Abnormal GI immune function
  3. Changes in colonic microbiota
  4. Abnormal central pain processing of afferent gut signals (altered brain-gut interactions)
  5. Abnormal GI motility
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11
Q

What is visceral hypersensitivity partially caused by?

A

Failed antinociceptive pathways

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12
Q

What happens after infectious gastroenteritis?

A

Raised serotonin-containing enteroendocrine cell concs. develop

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13
Q

Aetiology of IBS

A

Disordered bowel motility
Diet
Lifestyle
Psychological stress

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14
Q

GI contributing factors to IBS

A

Food intolerance
Lactose intolerance
Infection
Genetic factors

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15
Q

Possible risk factors of IBS

A

Genetic
Enteric infections (following gastroenteritis)
Dietary factors
Drugs (Abx)
Psychosocial (stress, anxiety or depression)

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16
Q

Why are psychosocial factors a risk factor for IBS?

A

Influence physiological function of GI via brain-gut axis, may affect person’s pain, symptoms, treatment and clinical outcome

17
Q

Diagnosis of IBS

A

Abdominal pain/defecation relief/altered bowel movements/stool form
+2:
Altered stool passage, bloating, worse eating, passing mucus
(lethargy, nausea, upper GI)

18
Q

IBS triggers

A

GI infection, Abx, pelvic surgery, psychological stress/trauma, sexual, physical, verbal abuse, mood disturbances, anxiety, depression, eating disorders, food intolerance

19
Q

Alarm indicators for other diseases in IBS

A

Age >50 years
Male
Short history of symptoms (<6 months)
Documented weight loss
Nocturnal symptoms
Family Hx of colon cancer
Rectal bleeding
Recent Abx use

20
Q

Exclude other diagnoses from IBS

A

Full blood count - anaemia, raised Plt count
ESR (erythrocyte sedimentation rate)
CRP (C-reactive protein)
Antibody test for coeliac antibodies (EMA) or (TTG)

21
Q

ROME process

A

International effort to create scientific data to help diagnosis & treat functional GI disorders (IBS, functional dyspepsia & rumination syndrome)

22
Q

Sub-types of IBS

A
  1. Diarrhoea predominant (IBS-D) - commonest
  2. Constipation predominant (IBS-C)
  3. Mixed, fluctuating between diarrhoea and constipation (IBS-M)
  4. Unclassified (IBS-U)
23
Q

Lifestyle advice for IBS

A

Relaxation & increase physical activity
Restrict tea/coffee/alcohol/fizzy drinks but >8 cups of water or similar a day
Discourage aloe vera use
Advise weight loss
Avoid insoluble fibre (bran, corn or wheat) but if increased fibre needed then soluble (nuts, oats, ispaghula) - oats useful if wind & bloat is an issue
Probiotics >4 weeks
FODMAPS

24
Q

What is a low FODMAP diet?

A

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
(Short chained carbs (sugars) that small intestine absorbs poorly, very restrictive & only with dietician support)

25
Q

Non-GI features of IBS: gynaecological

A

Painful periods (dysmenorrhoea)
Painful sexual intercourse (dyspareunia)
Premenstrual tension

26
Q

Non-GI features of IBS: urinary

A

Frequency
Urgency
Nocturia
Incomplete emptying of bladder

27
Q
A
28
Q

Non-GI features of IBS: other

A

Back pain
Headache
Bad breath - unpleasant taste in mouth
Poor sleep
Fatigue

29
Q

Medication options for IBS

A

If abdominal pain with spasms, consider antispasmodics (mebeverine, alverine, peppermint oil)
Constipation bulk forming laxatives such as ispaghula, if not tolerated, consider additional laxative like macrogol
Diarrhoea consider loperamide first line

30
Q

Why do we not use lactulose in constipation?

A

Osmotic so makes it worse

31
Q

Examples of bulk forming treatments in IBS

A

Ispaghula husk, methylcellulose, sterculia, Bran)

32
Q

When are bulk forming treatments most appropriate in IBS

A

Most appropriate where dietary fibre cannot be increased & the patient has hard stools, haemorrhoids, anal fissures

33
Q

Onset, side effects and contraindications of bulk forming treatments

A

12-36 hrs
Flatulence & distention
Colonic atony, obstruction, impaction

34
Q

What is loperamide?

A

Synthetic opioid analogue
Opioid-receptor and acts on μ-opioid receptors in the myenteric plexus of large intestine

35
Q

Properties of loperamide

A

High affinity for opiate receptors in gut
Extensive first pass metabolism (very little reaches systemic circulation)
Unlikely to cause opiate side effects (not cross BBB barrier - no addictive effects)

36
Q

What medication to try for IBS if severely constipated for >12 months and all classes of laxatives?

A

Linaclotide (guanylate cyclase C agonist) which promotes secretion of intestinal fluid and speeds up bowel transit
Review after 12 weeks
TCAs (amitriptyline) at low doses for refractory abdominal pain
Review after 4 weeks and increase dose if needed
Consider SSRI is TCA not effective (off label use)

37
Q

When to give prucalopride in IBS?

A

Tried 2 different types of laxatives at highest recommended doses, for 6 months & has not helped constipation and you & doctors are considering invasive treatment for constipation

38
Q

What is prucalopride? Cause what? Costs how much?

A

5HT4 receptor agonist - cause nausea (10% patients) and prolong QT intervals, studies against placebo, cost £59.52 per month

39
Q

What does prucalopride alter?

A

Colonic motility patterns via serotonin 5-HT4 receptor stimulation: stimulates proximal colonic motility, enhances gastroduodenal motility & accelerated delayed gastric emptying

Pharmacy (23 decks)

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