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Clin Med 3 > E1: IBS, Constipation, Diarrhea > Flashcards

E1: IBS, Constipation, Diarrhea Flashcards

1
Q

What is IBS?

A

A functional bowel disorder characterized by recurrent abdominal pain AND altered bowel habits

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2
Q

What are the red flag symptoms associated with IBS?

A
  • Severe onset after age 50
  • severe or progessively worsening symptoms
  • nocturnal symptoms
  • fevers/vomiting
  • unexplained weight loss
  • melena, hematochezia, and occult blood
  • Unexplained Fe deficiency anemia
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3
Q

What are the Co morbid conditions often seen with IBS?

A

Fibromyalgia, interstitial cystitis,dyspareunia, and dyspepsia

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4
Q

Patient presents with chronic, recurrent abdominal pain of variable intensities. Patient complains of altered bowel habits. What are you concerned about?

A

IBS

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5
Q

What is the Rome criteria for IBS?

A
  • Recurrent abdominal pain on average at least one day per week in the last 3 months associated with two or more of the following criteria
    1) related to defecation
    2) associated with change in stool frequency
    3) Associated with a change in stool form
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6
Q

What is the scale that is used to determine the classification of IBS according to the patients predominant symptoms?

A

The Bristol stool scale

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7
Q

How is IBS diagnosed in a patient with typical history and no alarm features?

A
  • Limited lab screening

- CBC, CMP, TSH, ESR/CRP, H pylori testing

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8
Q

How is IBS diagnosed in a patient with atypical history and alarm features?

A
  • Lab and stool studies
  • cross sectional/small bowel imaging
  • endoscopy and colonoscopy with biopsies
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9
Q

What is the initial management in IBS?

A

-Dietary, lifestyle, and behavioral modifications

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10
Q

What are the dietary/lifestyle/and behavioral modifications that can be used to treat IBS?

A
  • Food diary, symptomatology log to ID trigger foods
  • High fiber
  • adequate hydration
  • reconcile offending medications
  • Low FODMAP diet
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11
Q

What are the pharmacologic options are used to treat the abdominal pain associated with IBS?

A
  • Antispasmodics (dicyclomine, hyocyamine, and peppermint oil)
  • Antidepressants (TCA and SSRI)
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12
Q

What are the pharmacologic treatments of constipation associated with IBS?

A
  • Fiber (Psyllium)
  • Stool softeners
  • osmotic and stimulant laxatives
  • polyethylene glycol
  • prosecretory agents
  • 5HT4 agonist
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13
Q

What are the pharmacologic treatments of diarrhea associated with IBS?

A
  • OTC anti-diarrhea (loperamide)
  • Bile acid sequestrants
  • rifaximin
  • eluxadoline
  • 5-HT3 antagonist
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14
Q

What is the most common digestive complain in the general population?

A

Constipation

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15
Q

What conditions are functional constipation?

A

Chronic idiopathic constipation and IBS-C

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16
Q

What medications may induce constipation?

A

Opioids, anticholinergics, antipsychotics, iron, antacids

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17
Q

What are the defecation and obstructive disorders that may cause constipation?

A

Pelvic floor dysfunction, rectal prolapse, rectocele, colon cancer, and polyps

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18
Q

What are the metabolic syndromes that may cause constipation?

A

Hypercalcemia, hyperparathyroidism, hypothyroidism, DM, pregnancy, MS, Parkinson’s

19
Q

What is the clinical presentation of constipation?

A

-25% of defecations are associated with <3 spontaneous BMs/week. Lumpy or hard stools, straining, manual maneuvers, sensation of anorectal obstruction, and sense of incomplete evacuation

20
Q

What is dyssnergic defecation?

A

When there is paradoxical contraction of the external anal sphincter which impedes defecation

21
Q

What tests can be performed for patients with refractory constipation?

A
  • Sitz marker study
  • Defecography
  • Anorectal manometry
22
Q

What is a sitz marker study?

A

evaluates colonic transmit, measures movement of radiopaque markers through the colon via a series of X-rays

23
Q

What is a defecography?

A
  • Radiological imaging to assess the mechanics of defecation using fluoroscopy
  • assesses the anatomy and function of anorectum and pelvic floor
24
Q

What is anorectal manometry?

A

Measures the anal sphincter pressure/function

25
Q

What is the first step in treating constipation?

A
  • treat secondary and contributing cause of constipation

- reconcile offending meds

26
Q

What are are the lifestyle modifications that can help treat constipation?

A
  • Increase fiber and fluid intake
  • increase activity and exercise
  • bowel habit training
27
Q

What are the pharmacologic options for treating constipation?

A
  • Fiber supplements
  • stool softeners
  • osmotic laxatives
  • stimulant laxatives
28
Q

What are the prescription only agents used to treat constipation?

A

Lubiprostone, Linaclotide, and Plecanatide

29
Q

What are the adverse effects of fiber supplements?

A

Flatulence, bloating, and distention

30
Q

What are the adverse effects of stool softeners?

A

GI cramping

31
Q

What are the adverse effects of osmotic laxatives?

A

GI discomfort, bloating, caution with Mg containing laxatives and hypermagnesemia in patients with renal insufficiency

32
Q

What are the adverse effects of stimulant laxatives?

A

GI cramping, rarely lyte disturbances, and Melanosis coli

33
Q

What are some complications that can arise from constipation?

A
  • hemorrhoids/anal fissures
  • fluid and electrolyte abnormalities from laxative abuse
  • Fecal impaction and bowel obstruction
34
Q

What constitutes diarrhea?

A

Passage of ≥3 unformed stools/day

35
Q

What is the most common cause of diarrhea?

A

Infectious, particularly viral

36
Q

What are the red flag symptoms associated with diarrhea?

A
  • Fever
  • unexplained weight loss
  • melena, hematochezia
  • persistent/progressive/nocturnal symptoms
  • immunocompromised
  • Signs of volume depletion
  • IDA
37
Q

What is the clinical presentation of non-inflammatory diarrhea?

A
  • watery, non-bloody diarrhea, nausea and vomiting

- mild diffuse abdominal cramping, bloating, and flatulence

38
Q

What are the most common causes of non inflammatory diarrhea?

A

Norovirus and giardia

39
Q

What is the clinical presentation of inflammatory diarrhea?

A
  • Fever
  • bloody diarrhea
  • severe abdominal pain
40
Q

What are common etiologies of inflammatory diarrhea?

A

-CMV, salmonella, campylobacter, shigella, E. coli, C diff

41
Q

What symptoms associated with diarrhea warrants prompt evaluation?

A
  • Signs of inflammatory diarrhea (fever ≥ 101.3, leukocytosis, bloody diarrhea, and severe abdominal pain)
  • intractable vomiting
  • profuse watery diarrhea and dehydration
  • AKI
  • immunocompromised
42
Q

What is the management of diarrhea?

A
  • oral rehydration therapy
  • trial of lactose free diet
  • possible anti diarrhea agents
43
Q

What are the antidiarrheal agents that may be used for diarrhea?

A
  • Loperamide (Imodium)

- Bismuth Subsalicylate (peptobismol)(adverse effect is black stool)

Clin Med 3 (17 decks)

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