Chronic enterocolitis (irritable bowel syndrome, gluten sensitive enteropathy

Question 1

Chronic enterocolitis definition

Answer 1

A group of diseases characterised by inflammation of the small and large intestine

Question 2

Etiology/causes of Chronic enterocolitis

Answer 2

Infections (cholera TB
Viral infection
Food
Crohnsdisease (auto immune disease

Question 3

Irritable bowel syndrome (IBS)

Answer 3

I Irritable bowel syndrome is a functional bowel disorder in which
abdominal pain or discomfort is associated with defecation
and/or a change in bowel habit.

Question 4

Causes

Answer 4

Stress
Age
Meals (fatty sugary
Genetics

Mental health conditions: Anxiety, depression, and other mental health disorders are commonly associated with IBS.
* Food sensitivities: While not allergies, some people find that certain foods trigger their IBS symptoms.
* Gut motility issues: Problems with the muscle contractions that move food through the digestive tract.
* Brain-gut axis dysfunction: Disruptions in the communication between the brain an

Question 5

Classification

Answer 5

IBS-D (Diarrhea-predominant): Frequent loose or watery stools.
* IBS-C (Constipation-predominant): Infrequent bowel movements or hard, difficult-to-pass stools.
* IBS-M (Mixed): Alternating between diarrhea and constipation.
* IBS-U (Unsubtyped): When symptoms don’t clearly fit into the other categories.

Question 6

Clinical symptoms

Answer 6

Abdominal pain
 Pain frequently is diffuse without radiation. Type
of pain: intermittent or continuous. Common
sites of pain include the lower abdomen,
specifically the left lower quadrant.
 Meals may precipitate pain, and defecation
commonly improves pain. Defecation may not
fully relieve pain.
 Pain from presumed gas pockets in the splenic
flexure may masquerade as anterior chest pain or
left upper quadrant abdominal pain.
 Nocturnal pain is unusual in IBS and is
considered a warning sign • Abdominal distention
• Patients frequently report increased amounts of bloating and gas.
• People with IBS may manifest increasing abdominal circumference
throughout the day. They may also demonstrate intolerance to
otherwise normal amounts of abdominal distention.
• Borborygmi (a rumbling, growling or gurgling noise produced by
movement of the contents of the gastrointestinal tract as they are
propelled through the small intestine by a series of muscle
contractions called peristalsis)
• Flatulence (is the accumulation of excess gases in the digestive tract
due to their increased formation or insufficient discharge Abnormal eating habits:
- irregular or inadequate meals,
- insufficient fluid intake,
- excessive fiber intake.
• Obsession with dietary hygiene (food hygiene is a set
of food manufacturing practices that aim to minimise
biological food hazards through safe and clean
operations to protect public health from foodborne
diseases Lethargy, fatigue
• Backache and other muscle and joint pains
• Fibromyalgia
• Headache
• Urinary symptoms:
• Nocturia
• Frequency and urgency of micturition
• Incomplete bladder emptying
• Dyspareunia (painful sexual intercourse due to medical or
psychological causes) and poor libido
• Insomnia
• Low tolerance to medications in general Anxiety
•Depression
•Somatization
•Hypochondriasis
•Symptom-related fears
•Catastrophizin

Question 7

Diagnosis

Answer 7

CBC count with differential to screen for anemia, inflammation,
and infection
2. A comprehensive metabolic panel to evaluate for metabolic
disorders and to rule out dehydration/electrolyte abnormalities in
patients with diarrhea
3. A hemoccult test may be useful to rule out gastrointestinal
bleeding
4. Microbiologic studies include the following stool examinations:
- ova and parasites: consider obtaining specimens for Giardia antigen
as well
- enteric pathogens
- leukocytes
- clostridium difficile toxin
Stool sample
Breath test
Endoscopy
Ultrasound 5. Breath testing: screen for lactose and/or fructose
intolerance.
6. Thyroid function tests: screen for hyperthyroidism or
hypothyroidism.
7. Serum calcium: screen for hyperparathyroidism.
8. Erythrocyte sedimentation rate or C-reactive protein:
nonspecific screening test for inflammation.
9. Hydrogen breath test to exclude bacterial overgrowth
may be considered in patients with diarrhea

Question 8

Treatment

Answer 8

Diet
Mange stress
Amanage anxiety depression Antidiarrheals
- nonabsorbable synthetic opioids.
They prolong GI transit time and decrease secretion via peripheral µ-
opioid receptors. They reduce visceral nociception via afferent
pathway inhibition.
Diphenoxylate hydrochloride 2.5 mg with atropine sulfate 0.025 mg
(Lomotil)
Loperamide (Imodium)
Eluxadoline, a mu opioid receptor agonist and delta opioid receptor
antagonist, was approved for diarrhea-predominant Prokinetics
- promotility agents, proposed for use with constipation-
predominant symptoms.
Cisapride monohydrate (Propulsid)
Tegaserod (Zelnorm