B5.063 Prework 1: Bowel Disorders

Question 1

definition of IBS

Answer 1

recurrent abdominal pain associated with defecation or a change in bowel habits
disordered bowel habits, bloating, and distention often present
6 months of symptoms, present during the last 3 months

Question 2

rome 4 for IBS

Answer 2

recurrent ab pain on average, at least 1 day per week in the last 3 month, associated with 2 or more of the following:

1. related to defecation
2. associated with a change in frequency of stool
3. associated with a change in form (appearance) of stool

Question 3

alarm features

Answer 3

fam history of colorectal cancer
rectal bleeding w/o hemorrhoids/fissures
unintentional weight loss
anemia
nocturnal defecation

Question 4

subtypes of IBS

Answer 4

IBS-C: more than 1/4 hard, less than 1/4 soft
IBS-D: more than 1/4 soft, less than 1/4 hard
IBS-M: more than 1/4 hard, more than 1/4 soft
IBS-U

Question 5

psychosocial comorbidities of IBS

Answer 5

psychiatric distress
sleep disturbance
anxiety, depression
migraines

Question 6

treatment of IBS

Answer 6

lifestyle modifications
FODMAP
laxatives

Question 7

what is FC

Answer 7

symptoms of difficult, infrequent, or incomplete defecation predominate
should not meet IBS criteria, pain not predominant
6 months of symptoms, present during the last 3 months

Question 8

rome 4 FC criteria

Answer 8

2 of the following:

1. straining during more than 1/4
2. hard stool more than 1/4
3. sensation of incomplete evacuation more than 1/4
4. sensation of anorectal obstruction more than 1/4
5. manual maneuvers more than 1/4
6. fewer than 3 bowel movements per week

Question 9

treatment of FC

Answer 9

eliminate meds
fiber
bathroom time
laxatives

Question 10

definition of OIC

Answer 10

change, when initiating opioid therapy, from baseline bowel habits and defecating patterns that is characterized by any of the worsening of straining; a sense of incomplete evacuation; or a patient’s perception of distress related to bowel habits

Question 11

rome 4 OIC criteria

Answer 11

same as FC, but temporal relationship with opioids needs to be demonstrated

Question 12

treatment of OIC

Answer 12

initially like FC, but can add if necessary
opiod + naloxone
OR
peripherally acting antagonists (methylnaltrexone, alvimopan, naloxegol)