IBS Flashcards
Constipation Outline
Symptom (not condition), actute/chronic. Infrequency and difficulty in emptying bowel . Indicated by straining, >3 bowel movements a week and passing herd stools. Risk factors: pregnancy and old age (changing hormones)
Indications of constipation severity
patient over 50 years, anaemia, abdominal pain, dry blood in stool (bleeding in intestines) and weight loss
Constipation Presentation
Nausea, abdominal swelling, defecation straining and cramping.
Constipation Complications
Hemorrhoids, anal fissure, faecal impaction (faeces stuck in GIT), rectal prolapse (rectum sticking out of anus
Anal Fissure Outline
Indicated by bright red blood in stool. Tear in anal tissue. Self limiting
Heammaroids Outline
Swellings in tissue that enclose blood vessels
Constipation Causes
Slowing of food transit in LI (more water absorption, low dietary fibre and water intake, decreased exercise and medication (decreaing intestine motility/secretions, increasing intestinal fluid absorption and bulk/complex formation in GIT (physical barrier))
Stool Type that spends longest time in bowel
Type 1
Ideal Stool Type
Type 4
Stool type that spends least time in bowel
Type 7
Constipation Treatment
Lifestyle (increase water/fibre/exercise), laxatives, (secondline) linaclotide and prucalopride
Types of Laxatives
Bulk forming, stimulant, faecal softening and osmotic
Bulk Forming Laxatives Outline
Useful for patients who can’t increase fibre in diet. Increases fecal mass stimulating paralysis. Action:12-36 hours. Side effects: abdominal distention and flatuelence. Adequate fluid intake essential to avoid obstruction
Bulk Laxative Examples
Bran, methylcellulose, ispaghula husk and sterculia
Stimulant Laxatives Outline
Stimulant effect on GI mucosa, increasing motility. Onset: 6-12 hours. Side effects: abdominal cramps and nerve damage after long term use. Caution: pregnancy, avoid intestinal obstruction
Stimulant Laxative Examples
Bicasydol, sodium picosulfate and senna
Fecal Softener Laxatives Outline
Decrease surface tension and increase intestinal fluid penetration into fecal matter
Fecal Softener Laxatives Examples
Docusate and glycerol (mild irritant). Liquid paraffin isn’t used as it’s toxic. Onset: 3 days
Osmotic Laxative Outline
Increases amount of water in bowel. Either by drawing water into bowel or retaining liquid they were administered with. 2 types: Macrogols and Lactulose. Onset: 1-3 days. Side effects: diahorrea, nausea and abdominal cramps. Require constsnt hydration to avoid dehydration
Macrogols Outline
Inert polymers of ethylene glycol which sequestered in bowel fluid. Increasing stool volume, increasing bowel motility
Lactulose Outline
Semi-synthetic disaccharide not absorbed by GIT. Lowers pH of gut increasing osmosis
Linaclotide Outline
Second line treatment. Guanylate cyclase C receptor agonist. Treats moderate-severe IBSc. Increases fluid secretion and transit, decreasing visceral pain
Prucalopride Outline
Selective serotonin 5HT4 receptor agonist (prokinetic qualities). Treats chronic constipation in adults. Risk: renal impairment
Diahorrea Def.
Symptom (not disease). Abnormal passing of loose/liquid stool with increased frequency/volume. Typically self limiting
Acute Diahorrea
Diahorrea lasting > 14 days. Typically infection caused by gastric mucosa damage or pathogen produced toxin
Persistent Diahorrea
Diahorrea lasting 2-4 weeks
Chronic Diahorrea
Diahorrea lasting 4+ weeks. Caused by chronic GI disorder (eg Chronn’s, colitis, IBS) or medication (osmotic/motility diahorrea)
Diahorrea Complications
All linked to dehydration. Confusion, coma, shock, tachycardia, oliguria (reduced urine) and/or anuria (no urine)
Diahorrea Red Flag Symtoms
persistent vomiting, weight loss, sleep disruptions and recent hospital visit/ antibiotic course
Osmotic Diahorrea Outline
Stop when feeding stops.
Secretory Diahorrea Causes
Fluid extensivity due to enterocyte toxin or other inflammatory response
Diarrhoea Treatment Aims
Prevent/manage dehydration and avoid/treat cause
Oral Rehydration Therapy
Glucose-electrolyte solution. Glucose, sodium and water are absorbed on a 1:1:1 basis. Citrate present to counteract acidosis
Loperamide Outline
Antimotility drug. Binds to gut opiate receptors inhibiting ACh and prostaglandin release. This reduces peristalsis rate, increaing transit time. Enhances water reabsorption. Increases anal sphincter tone, improving consistency. Onset: 9-14 days. Only used when patient can’t acess a toilet
When to not use Loperamide and side effects
Avoid when mucus/blood in stool with high fever, ulcerative colitis and AIDS (risk of toxic megacolon).
IBS Outline
Chronic, relapsing condition. Symptoms overlap with a lot of other diseases (abdominal pains, stools change). Varying symptom profiles: IBSC, IBSD and IBSM
IBSM Outline
Irritable bowel syndrome where symptoms oscillate between presentation of diahorrea and constipation
IBS Diagnostic Criteria
ROME 4 Diagnostic Criteria and NICE Guideline
IBS Diagnosis
Recurrent abdominal pain for 1 week every 3 months. Associated with change in frequency/form. Symptom onset was 6 months before diagnosis. Abdominal bloating/distension/hardness/tension and passage of mucus. Made worse by eating
IBS Diagnostic Tests Outline
Used to exclude other diagnosises. Full blood count, erythrocyte sedimentation, c-reactive protein and coeliac antibody tests
IBS Management: Dietary Advice
Have regular meals, drink 8 glasses of water a day, restrict tea/coffee/fizzy drinks/alcohol drinking. Taoiler to patient eg IBSC = increese in dietary fibre, IBSC = decrease in dietary fibre
FODMAP Outline
Substances to avoid when struggling with IBS, as they produce gas. Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Particularly beneficial in IBS with bloating and pain
IBS 1st line Pharmacological Therapy
Antispasmodic drugs, laxatives, loperamide and peppermint oil
IBS 2nd line Pharmacological Therapy
Tricyclic antidepressents and selective serotonin uptake inhibitor
Antispasmodic Outline
Empirically used. Treats smooth muscle spams assumed to be associated with IBS.
