IBS Flashcards
what does IBS stand for?
Irritable Bowel Syndrome
how long must you have symptoms of IBS before we can say it is IBS?
6 months
what makes abdo pain better in IBS?
- this is a requirement for it to be diagnosed as IBS
pain relieved by defecating
which age group is most at risk?
20-30
which gender is most at risk?
female
what happens to prevalence with age?
decreases
what foods/drinks can increase risk?
-give 4
alcohol
caffeine
spicy
fatty foods
which drug group commonly causes IBS?
antibiotics
what are the risk factors for IBS?
-7
GI infection GI inflammation diet psychosocial factors drugs younger age group female
how many people have their symptoms triggered by foods?
% wise
90%
what psychosocial factors can increase risk?
stress
anxiety
depression
what are the differentials?
- give 4
crohn’s
coeliac
cancer
UC
complications of IBS?
-2
depression, anxiety
does acupuncture help IBS?
no
pt has typical IBS Hx, but also has rectal bleeding.
what should be a differential now?
-2
cancer
UC
pt has typical IBS Hx, but also has weight loss.
what should be a differential now?
-3
crohn’s
coeliac
cancer
pt has typical IBS Hx, but these symptoms have started now at 68 years of age.
what should be a differential now?
cancer
pt has typical IBS Hx, but also has a FHx of cancer.
what should be a differential now?
cancer
what are the ABC symptoms of IBS?
Abdo pain
Bloating
Change in bowel habit (diarrhoea/constipation)
how long you do need the ABC symptoms of IBS before we can consider a diagnosis?
6 months
can you get mucus in stool in IBS?
yes
can you get blood in stool in IBS?
no
must be a different condition then
what type of diagnosis is IBS?
diagnosis of exclusion
what blood tests did NICE say you can use to exclude differentials?
-4
FBC
ESR, CRP
Coeliac serology
pt has just been diagnosed with IBS.
diarrhoea is main symptom.
what OTC can they try to help this?
how long for?
probiotics
4 weeks
pt has just been diagnosed with IBS.
constipation is main symptom.
what lifestyle change can they try to help this?
high fibre diet
is exercise recommended?
yes
what is the 1st line Mx?
change lifestyle factors
what is general diet advice?
-7
Eat regular don’t skip meals, drink water oats are good. No processed foods. Only 3 pieces of fruit/day. Less tea & coffee.
1st line Mx for diarrhoea failed.
What drug can be given now?
loperamide
1st line Mx for constipation failed.
What class of drug can be given now?
give an example of this class?
bulk forming laxative
fybogel
IBS pt has refractory constipation.
what drug can you try now?
which messenger molecule is upregulated by this drug?
how does this help constipation?
linaclotide
↑cGMP
stimulates water, Cl- & HCO3- secretion into intestine lumen
IBS pt has refractory abdo pain.
what is the 1st drug you should try?
amitriptyline
all lifestyle factors and drug options have been exhausted.
symptoms still there.
who can GP refer to now?
- 3 specialties
Refer to gastroenterologist
Refer to dietician
Refer to psychiatrist
moa of loperamide?
on which receptors in what plexus does it act?
which specific organ does it act in?
opioid-receptor agonist
μ-opioid receptors in the myenteric plexus
large intestine
moa of loperamide?
how exactly does loperamide help diarrhoea?
↓tone of smooth muscle in LI –> ∴food stays longer in LI –> more water absorbed from food into blood.
main effect of loperamide?
stops diarrhoea
