8.2: IBS Flashcards
Describe IBS, what is the condition’s prevalence in the population and which gender is more commonly affected?
Chronic, relapsing, functional bowel disorder
10-15% of population, females more affected than males 2:1
What is the NICE guidelines to make a diagnosis of IBS? (Try to recite the whole thing)
+ name an extra symptom that nobody will volunteer to tell you…
Symptoms should include:
1. Colicky pain in the L iliac fossa or discomfort that is released by defecation or passing wind
- Change in bowel habit; may include disordered defecation (diarrhea and constipation)
- Abdominal distension/bloating
Consider a diagnosis if:
-the pain/discomfort is relieved by defecation or associated with altered bowel frequency/stool form
-should be accompanied with at least 2 out of the 4 following symptoms
A) altered stool passage; straining, urgency, incomplete evacuation
B) abdominal bloating
C) symptoms made worse by eating
D) passage of mucus
Other features may support the diagnosis: lethargy, nausea, backache and bladder symptoms
+ fecal incontinence: unexpected leaking of bowels out the rectum
Why is IBSD a red flag?
IBS with diarrhea can be a sign of cancer (in a certain age range)
What are the causes and risk factors for IBS?
Hint* list five potential causes and three risk factors
Unknown and likely multifactorial, possibly an…
- organic trigger
- psychological component
- sufferers can have abnormalities in the GI tract muscle tone which results in abnormal rises in intraluminal pressure and disordered peristalsis - causing small volumes of stool which become progressively dehydrated and fragmented (rabbit poop).
- Low fibre diet likely exacerbates the condition
- possible genetic component as well
Risk factors:
1/14 with bacterial gastroenteritis develop IBS, female, long period of diarrhea
What is the common age group affected by IBS
20-30 years
What is the Rome IV diagnostic criteria for IBS
At least 12 weeks (which don’t need to be consecutive) preceding 12 months of abdominal discomfort or pain with 2/3 following features:
- Relieved by defecation and/or
- Associated with change of frequency of stool and/or
- Associated with change of consistency of stool
What are the four major red flag symptoms? (Not including IBSD) What happens if any of these are identified (specifically on the basis of suspecting two conditions)
- Have unexplained weight loss and abdominal pain and are 40+
- Have unexplained rectal bleeding and are 50+
- Have iron deficiency anemia, changes in bowel habit or fecal occult blood and are 60+
- Have abdominal pain, changes in bowel have, weight loss, iron deficient anemia and are under 50 with rectal bleeding
If identified referrals are to be seen within 2 weeks to exclude colorectal cancer and urgent appts are made for potential of IBD
What tests (and test results) would indicate iron deficient anemia and any inflammation?
FBC (would show low Hb), CRP, LFT, ESR (erythrocyte sedimentation rate or plasma viscosity)
Name the 3 key differentials for IBS and 6 more just for fun!
The acronym for the 6: GVIPCCCD
Key differentials: coeliac disease, colorectal carcinoma, IBD
Extras: Gynaecological disorders, intestinal parasites, vascular insufficiency, psychiatric disorder, chronic constipation or chronic diarrhea
What might you test when checking for celiac disease
Endomysial antibodies, tissue transglutaminase
Name five other investigations you might give a patient with suspected IBS who is also experiencing indigestion and has travelled abroad
Ultrasound, colonoscopy, barium enema, fecal ova and parasite test, hydrogen breath test (for lactose intolerance and bacterial overgrowth)
What is fecal calprotectin, where is it secreted and how can it be helpful?
Excreted by neutrophils and other inflammatory cells as a result of inflammation into the intestinal lumen
Therefore, it is a marker for inflammation and can distinguish between IBD and non-inflammatory bowel disease (which includes IBS)
How is IBS treated (beginning from when a patient with suspected IBS walks in)
- History and investigations - using NICE guidelines and Rome IV Diagnostic criteria
- Look for red flags and if present consider a specialist review
- Consider pharmacological and psychological interventions (i.e stool softeners, laxatives, tricyclic antidepressants can also help regulate abnormal bowel functions, SSRIs, etc)
- Diet and lifestyle advice
What organ might be specifically tested as part of the initial screening test for IBS?
Thyroid function test
What kind of dietary and lifestyle advice can be included in treatment of IBS?
Food diary, “exclusion diet” to identify any food triggers, limit high fibre and caffeine and increase water intake. Increase exercise
