IBS Flashcards
This was not very complex...he better go simple.
How is IBS characterized?
chronic abdominal pain + altered bowel habits in the absence of any known organic cause
Epidemiology of IBS?
Female :Male 2:1
symptoms at <45 years of age
Pathophysiology of IBS? (5)
- Motility disorder
- Visceral Hypersensitivity
- Intestinal Inflammation
- Intestinal Microbial changes
- Psychological
Main culprit of symptoms on IBS?
abn colonic motility
What causes pain in IBS?
Increased visceral sensitivity to pressure and pain stimulus
What IBS symptoms may result from slow GI transit?
bloating and distension (which are painful due to hypersensitivity)
How can we tell intestinal inflammation may be present in IBS?
increased inflammatory markers (TNF and other cytokines)
What microbial abn may be present in IBS?
Post Infectious IBS
Alteration in Gut microbes
Bacterial Overgrowth
IBS patients tend to be more freq diagnosed with:
psychological disorders
particularly, abuse
Possible mediating factor related to IBS and psych disorders?
Corticotropin Releasing factor
Rome III Diagnostic Criteria for Irritable Bowel Syndrome Irritable Bowel Syndrome:
Recurrent abd pain or discomfort for 3 consecutive days a month in last 3mo associated with 2 or more of the following:
- Improvement w/ defecation
- Onset asst’d w/ change in freq of stool
- Onset asst’d w/ change in appearance of stool
According to the Manning criteria, likelihood of IBS increases with presence of what symptoms?
- Pain relieved with defecation
- More frequent stools at onset of pain
- Looser stool at the onset of pain
- Visible abdominal distention
- Passage of mucus
- Sensation of incomplete evacuation
IBS-C is associated with…
IBS-D is associated with…
Hard stool >25% of stool
Loose/watery stool >25% of stool
Mixed IBS is associated with…
Loose and hard stool alternate >25% each
Diarrhea in IBS is defined/characterized as…
frequent (>3 stools/day) non-bloody stools of small volume that may be associated with urgency or feeling of incomplete evacuation
What is the timing of diarrhea in IBS?
Usually AM or post-prandial, but does NOT awaken patient
Constipation in IBS is defined/characterized as…
< 3 stools/week which may be hard/pellet
Constipation may be constant or intermittent
Most frequent type of altered bowel habits seen in IBS?
Alternating Diarrhea/Constipation
Differential Diagnosis of Irritable Bowel Syndrome (FYI)
Abx-associated diarrhea Hypo/hyperthyroidism Medications Endometriosis Celiac Sprue Lactose intolerance Infectious diarrhea Colorectal cancer Diverticulitis IBD
Red Flags in Diagnosis of IBS in history?
Hx of wt loss, severe chronic diarrhea or constipation, rectal bleeding
Onset of sx in patient >50 y/o
Recent travel or abx use
Family hx of GI cancer, sprue, or IBD
Red flags in Diagnosis of IBS in physical/labs?
arthritis, lymphadenopathy, abdominal mass
Anemia, abnormal thyroid tests, abnormal calcium, abnormal liver tests, leukocytosis
Treatment of IBS?
- Education
- Reassurance
- Dietary modification
- Drug treatment (for pain, constipation or diarrhea)
- Psychological treatment
Dietary Treatment of IBS?
For some pts: fatty foods, alcohol, caffeine, beans
Food diary
Drug treatment of IBS for nml patients?
Fiber (constipation)
Loperamide (symptomatic control of diarrhea)
Anti-cholinergics (pain and bloating)
Drug treatment of IBS for severe symptoms?
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitors
**antidepressants modulate GI motility, and may modulate visceral hyperesthesia
