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Gastrointestinal 2 > Clinical Presentation of Irritable Bowel Syndrome > Flashcards

Clinical Presentation of Irritable Bowel Syndrome Flashcards

1
Q

What is Irritable Bowel Syndrome (IBS)?

A
  • chronic abdominal pain and altered bowel habits in the absence of any organic cause.
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2
Q

What is the most commonly diagnosed GI condition?

A

IBS

*affects men and women (young and old), but usually middle aged WOMEN.

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3
Q

How does the Rome III diagnostic criteria define IBS?

A

recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, associated with 2 or more of the following:

  • improvement with defecation
  • onset associated with a change in frequency of stool.
  • onset associated with a change in form (appearance) of stool.
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4
Q

*** Is mucus in the stool uncommon in IBS?

A

NO it is very common.

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5
Q

What is the most common cause of work related absence?

A 
common cold
#2 is IBS.
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6
Q

What are the 4 subtypes of IBS?

A
  • IBS-C
  • IBS-D
  • IBS-M
  • IBS-U
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7
Q

What is IBS-C?

A
  • hard or lumpy stools greater than 25% of bowel movements (BMs).
  • loose or watery stools less than 25% of BMs
  • bristol stool form scale 1-2
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8
Q

What is IBS-D?

A
  • loose or watery stools greater than 25% of BMs
  • hard or lumpy stools less than 25% of BMs
  • bristol stool form scale 6-7
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9
Q

What is IBS-M?

A
  • both stool forms (diarrhea and constipation) greater than 25% of BMs
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10
Q

What is IBS-U?

A

both stool forms less than 25% of BMs

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11
Q

Is IBS considered a multi-symptomatic disorder?

A

YES

  • abdominal pain/discomfort (must have at least this).
  • trapped wind
  • diarrhea
  • bloating
  • constipation
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12
Q

What comorbidities are associated with IBS?

A
  • headache
  • poor sleep
  • fatigue
  • fibromyalgia
  • depression, anxiety
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13
Q

What are some other symptoms common in IBS patients?

A

GERD, dysphagia, early satiety, dyspepsia, nausea, non-cardiac chest pain, impaired sexual function, dysmenorrhea, dyspareunia, increased urinary frequency, fibromyalgia

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14
Q

What is the pathophysiology of IBS?

A

we don’t know.

- likely hereditary and environmental factors

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15
Q

What was the effect of rectosigmoidal balloon distention on pain in IBS patients vs. control?

A
  • IBS patients reported significantly more pain than control pts.
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16
Q

Is visceral hyperalgesia specific for IBS?

A

NO it occurs in other patients with chronic pain syndromes (esophageal chest pain, angina pectoris with normal coronary arteries, fibromyalgia)

17
Q

Was IBS found in about 1/3 of patients after acute bacterial infection (infections enteritis)?

A

YES especially after antibiotic use.

18
Q

Could alteration in fecal microflora (bacterial overgrowth) or food sensitivities be possible causes for IBS?

A

yes maybe

19
Q

Are patients with IBS more likely to have a history of physical or sexual abuse?

A

YES corticotropin releasing factor (CRF) has been shown to increased abdominal pain and colonic motility in iBS patients to a higher degree than controls.

20
Q

Does a typical IBS patient usually lose or gain weight?

A

GAINS weight.

21
Q

Does IBS cause you to wake from sleep?

A

NO!

22
Q

Does IBS cause GI/rectal bleeding?

A

NO!

23
Q

If the pts symptoms point to IBS and there are no alarm symptoms, should you run diagnostic tests?

A

NO, just treat them!

24
Q

What treatments have been used to treat IBS symptoms?

A
  • prescription medications, OTC laxatives, OTC antidarrheals, herbals…
  • fewer than 1/3 reported satisfaction
25
Q

How do we treat IBS?

A

no known cure, but treatment is to relieve symptoms.

26
Q

What is the MOST IMPORTANT component of IBS treatment?

A

establishing a strong therapeutic physician-patient relationship.

  • show empathy, acknowledge pain
  • listen actively
  • reassure
  • educate
  • be confident
  • positive placebo effects are significant
27
Q

What dietary restrictions may be used for IBS?

A
  • exclusion of gas-producing foods: beans, onions, celery, carrots, raisins, bananas, apricots, prunes, brussel sprouts, pretzels, and bagels.
  • low FODMAP diet (Fermentable Oligo-, Di-, and Mono-saccharides And Polyols).
28
Q

Is fiber proven to help IBS?

A

No but it is easy for pts to try and if it helps, great!

29
Q

Will physical activity help IBS?

A

YES

30
Q

*** What do we do for IBS-D?

A
  • antispasmodic agents (most frequently used agents in IBS).
  • hyposcyamine, dicyclomine, peppermint oil (smooth muscle relaxants with anticholinergic properties).
  • 5-HT3 antagonists (Alosetron) and may help the abdominal pain.
  • RIFAXIMIN= oral antibiotic, minimal systemic absorption, inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. EXTREMELY SAFE bc it stays in the GI tract and does not get absorbed systemically.
  • antidepressants (TCA’s and SSRI’s)= analgesic properties with facilitation of endogenous endorphin release. Use caution with a constipated patient bc they can slow intestinal transit via anticholinergic properties.
    More for resistant IBS patients.
31
Q

Will imodium help the diarrhea in IBS?

A

YES but will do nothing for the bloating and abdominal pain.

32
Q

** How do you treat constipation predominant IBS (IBS-C)?

A
  • consider PEG (polyethylene glycol)
  • osmotic laxative (may worsen abdominal bloating and cramping, but improves constipation). Monitor serum electrolytes.
  • C-2 chloride channel activator (lubiprostone)= enhances chloride-rich intestinal fluid secretion. EXTREMELY SAFE and can use indefinitely :)
  • Guanylate cyclase agonists (linaclotide)= stimulates intestinal fluid secretion and transit.
  • Rifaximin
  • Probiotics (no data that they work).
  • psychosocial therapies (hypnosis…)
33
Q

If you have a loop in your colon, are you more or less likely to have IBS?

A

5x MORE likely!

Gastrointestinal 2 (18 decks)

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