IBS-1 Flashcards
Which gender is IBS MC in? What age range is MC?
MC Female
Usually 18-34y/o
Which condition?
- Disturbance of GI motility (pain w/ abnl BM that is relieved w/ BM)
- Visceral hypersensitivity
- Co-morbid psych isuues
IBS
T/F: IBS is abdominal pain associated with BMs with many objective findings
FALSE.
IBS is abdominal pain a/w BMs, howevere, IBS does NOT have objective findings… only sxs
What criteria is used to diagnose IBS?
Rome IV Criteria
What are the components of the Rome IV criteria (used to dx IBS)
Recurrent abd pain at least 1 day/week x3 months
+
w/ bowel movement
Change in stool frequency/form
If you suspect a patient might have IBS, what else must you test for due to the fact that it can look exactly like IBS?
Celiac disease
(screen w/ IgA TTG or celiac panel)
A subgroup of patients report what prior to onset of IBS?
Acute viral or bacterial gastroenteritis
What would the physical exam look like in IBS?
Normal, +/- abd tenderness
Vitals normal, no pallor, no rash
What rash is seen in IBS? In Celiac Disease? In IBD?
IBS- none
Celiac- Dermatitis herpetiformis
IBD- erythema nodosum
What are the 9 Red flag symptoms of IBS?
1. Age of onset >50
2. Rectal bleeding or melena
3. Nocturnal diarrhea
- Progressive abd pain
- Unexplained weight loss
- Lab abnormalities (anemia, incr. WBC, incr. CRP, Incr. sed rate)
- Fam hx of IBD or colon cancer
- Recent abx (C. diff)
- Recent travel
In patients without alarm features, what rules out organic disease in >95% of patients?
Initial evaluation usually sufficient (CBC, celiac dz screen, CRP if diarrhea)
What is the most important piece of IBS management?
Positive clinician-patient relationship–> these patients show improvement
What is the treatment IBS in pts w/ mild & intermittent symptoms that don’t impair quality of life
- Lifestyle modification
- low FODMAPs diet- decrease fat intake, less oligo, di and monosaccharides, etc
- +/- lactose/gluten avoidence
- +/- fiber/psyllium
- Exercise 20-60 min 3-5 days/week
How do you treat someone w/ IBS-C that has severe sxs that impair their quality of life? (5)
- Lifestyle & diet modifications
- Osmotic laxatives- Miralax (if fail soluble fiber)
- Lubiprostone (If MiraLax doesn’t work)–> only women 18+
- Dicyclomine, Hyoscyamine (antispasmodics) for pain/bloating
- +/- Tricyclic antidepressants
How do you treat someone w/ IBS-D that has severe sxs that impair their quality of life? (6)
- Lifestyle/diet modifications
- Loperamide
- Bile acide Sequestrants- Cholestyramine (esp. if IBS s/p cholecystectomy)
- Antispasmodics- Dicyclomine, Hyoscyamine
- +/- Tricyclic antidepressants
- Antibiotic- Rifaximin (if significant bloating)
What are the 2 medications options to manage abdominal pain and bloating in IBS
Antispasmodics:
- Dicyclomine
- Hyoscyamine
What should you give patients with IBS without constipation and WITH significant bloating?
Antibiotics- Rifaximin x2wks
Which meds are good to give in a patient with IBS-D post cholecystectomy?
Bile acid sequestrants
What is the difference between IBS-C and constipation
Constipation looks like IBS-C but NO PAIN
Is constipation MC in men or women?
women
Criteria for diagnosing what?
- Rome IV (provider) Criteria- 2+ for the following 3 months, w/ sx onset >6 months prior to dx
- Straining
- lumpy/hard stools
- sensation of incomplete evacuation
- Sensation of anorectal blockage
- Manual maneuvers to facilitate defecation
- <3 spontaneous BMs per week
- Patient criteria- straining, hard stools, unproductive urges, infrequency, feeling of incomplete evacuation
- Constipation
What are the 6 components of the Rome IV (provider) criteria for diagnosing constipation
- 2+ for the following 3 months, w/ sx onset >6 months prior to dx
- Straining
- lumpy/hard stools
- sensation of incomplete evacuation
- Sensation of anorectal blockage
- Manual maneuvers to facilitate defecation
- < 3 spontaneous BMs per week
What are the 3 causes of constipation?
- Slow transit constipation (unknown cause)
- Pelvic floor dysfunction (inability to evacuate rectal contents- esp. women)
- medications
If you have a patient with constipation that has red flags (age, presence of occult blood, weight loss), how should you evaluate?
colonoscopy or flex sig
What do most patients c/o constipation receive as tx?
Trial of fiber supplementation and close follow up
What 2 diagnostic studies can be used in evaluating patients with refractory constipation?
- Colonic transit study
- Anorectal manometry (sphincter pressure)
What 3 physical exams can be performed when evaluating a patient with constipation?
- Anal wink
- DRE
- Pelvic- looking for rectocele
What are the 7 components of management for constipation?
- Adjust causative meds
- correct metabolic abnormalities
- push fluids
- increase exercise
- increase fiber to 20-30g/d
- Minimize laxative use (PEG- MiraLax)
- Go when pt has urge
What is the main complication of constipation?
fecal impaction–> can lead to LBO
How do patients present if they have a fecal impaction/LBO? (4 sxs)
- Anorexia
- Nausea
- Vomiting
- Abdominal pain
How do you manage a fecal impaction?
Manual removal of stool and/or w/ enemas
