IBS Flashcards
What is IBS?
Is a functional gastrointestinal disorder involving disturbance in bowel function affecting the sensorimotor function of the gut.
A syndrome with a diagnosis made of cluster of x in the absence of structural abnormalities.
What is fecal calproctectin?
A non- invasive market of mucosal inflammation.
Treatment decision made on disease is based on what?
Severity and and location rather than strictly by diagnosis.
Diagnosis for IBD are..
Patient history Various tests including blood tests. Stool tests (esp fecal calprotectin), Endoscopy Biopsies Imaging studies
In suspected IBD tests should aimed at what?
Differentiating IBD from infectious gastrointeritis and coeliac dse.
Ix also helps in defining dse activity and severity.
Lab test Ix should include blood and stool to rule out what?
Other causes of diarrhea and inflammation
Blood tests are not specific for IBD but may be done to detect and evaluate what?
Severity of inflammation
Anemia
Vitamin or mineral deficiency associated with IBD
FBC can reveal what?
Anemia - low mean corpuscular volume (MCV)
High MCV suggesting B12 or folate deficiency or seen in patients on immunomodulators such as thioprines
Normal MCV with high red cell distribution width (RDW) indicating iron and folate def or folate and vit B 12
WCC elevation - evidence of inflammation
Low Albumin
Inflammation and malnutrition
Raise creatinine and urea
Evidence of dehydration
Electrolyte disturbances
Low magnesium, selenium, potassium, zinc
Rrlated to poor diet and long standing diarrhea
Low ferritin
Iron def < 100 microgram
Elevated serum ferritin can be a marker of inflammationesp in liver rrlated inflammation
Non-celiac features includes
Fistulas
Perianal dse
Bloody stool
Fecal calprotectin is widely used neutrophil derived protien biomarker in Australia.
Highly sensitive, non invasive marker of intestinal inflammation therefore is useful in the ff settings.
What are they?
Differentiating people with or without lower gut inflammation bet people with IBS and IBD
Monitoring people on therapy to check disease activity or response to tx
Assess mucosal heal is achieved where colonoscopy is not practicable due to cost, access, patient comorbidities and Pt’s refusal
Stool testing with suspected IBD is valuable tool to determine enteric infections such as what?
Clostridium difficile (common in elderly, immunocompromised and on antibiotic therapy)
Tx of IBD w/ immunosuppression without addressing infectious pathogens can be dangerous
FOBT testing can reveal what?
Traces of blood that cannot be seen with the naked eye
A screening tests for colorectal ca and should not be used as a diagnosis for IBD
Other stool culture for patients who travelled abroad to check infectious diseases
Endoscopy and colonoscopy with histology and radiology are used for what?
Diagnosis of IBD to assess it’s extent and severity
To prevent young Pt’s from unnecessary exposure to radiation by using MRI over CT if possible
First line procedure to establish diagnosis and extent of IBD
Colonoscopy with ileoscopy with multiple biopsy specimens
Endoscopy is used for
Visual exam of the the entire lining of large intestine
Examine ulcers, inflammation, bleeding, stenosis
Multiple biopsies from the colon to TI
Lack of response to tx
Assess CMV infections - testing on biopsies, PCR. Pt’s on chronic use of immunosuppressants or w/ C diff infection appearances suggests pseudomembranes
Colonoscopy for dysplasia surveillance
Upper GI endoscopy is ised for upper GI sx such as nausea, vomitting, epi pain
Capsule endoscopy is used for what?
To assess presence, extent and severity of small bowel involvement in Crohn’s dse
Stricturing Crohn’s dse is a contraindication
Plain abdo xray is used for?
Wether colitis is present and its extent in some cases of UC
Exclude toxic megacolon with acute severe colitis
Give impression of mass on RIF or show dilatation or obstructions on CD
Barium double contrast enema
Is rarely used and is replaced by colonoscopy.
When is it helphlful?
In rare circumstances when colonoscopy is incomplete or to delineate the lenght of a colonic stricture
When is USS and MRI used?
To determine the extent and severity of the disease to assess for perforating complications
Intestinal USS permits a real time assessment of disease activity including what are they??
Quantifying inflammatory burden that assist in determining the inflammatory and fibrotic components of a stricture
Determine sx are due to active diseases or due to functional issues such as faecal loading.
It is non- invasive, don in an unprepped bowel
Relatively safe