IBS Flashcards
Irritable bowel syndrome is a combination of the three following factors
- altered GI motility
- smooth muscle hypermotility
- visceral hyperalgesia
- increased perception of visceral pain
- increased perception of normal motility
- psychopathology
- co-morbid psychological issues
Irritable bowel syndrome comes in what 3 types
- constipation-predmoninant
- diarrhea-predominant
- pain-predominant
hallmark signs/symptoms of Irritable bowel syndrome
- abd pain relieved by defecation
- pain associated with looser or more frequent stools
clinical presentation
- lasts for days/months with periods of normal bowel function or diarrhea
- stools are hard and may be followed by sensation of incomplete evacuation
- strain with defecation
constipation predominant IBS
clinical presentation
- frequent loose stools
- typically occurs in morning and after meals
- preceeded by urgency and may be followed by sensation of incomplete evacuation
- mucus discharge with stool
diarrhea-predominant IBS
clinical presentation
- crampy abd pain of variable intensity with periodic exacerbations
- alternating diarrhea and constipation
- stress and eating may exacerbate, defecation provides relief
pain-predominant IBS
what criteria can be used to evaluate IBS
- Rome criteria III: recurrent abd pain at least 3 days per month in the last 3 months and associated with 2 or more of the following
- improvement with defecation
- change in frequency of stool
- onset associated with a change in form (appearance) of stool
ABC diagnosis of IBS
- Abdominal pain
- Bloating
- Change in bowel habits/stool consistency
red flags when assessing for IBS
- FHx of colon CA, IBD, or celiac disease
- Anemia, GI bleed
- Weight loss
- fever, vomiting
- dysphagia
- steatorrhea
- nocturnal symptoms
- h/o abx use
- recent travel
are labs/diagnostics usually done to assess IBS
- not routinely recommended unless there are alarm features
- CBC
- CMP
- ESR, CRP
- TSH
- Hemocult
- Stool studies: ova and parasites
management options for all types of IBS
- reassurance: legitimize complaint
- large placebo effect
- anticholinergic (antispasmotic)
- Bentyl
- Fiber supplement
- stress management
rome criteria for diagnosis of constipation
- stool frequency (< or = 2 stools per week), straining, hard stools, and a feeling ofi ncomplete evacuation
3 common causes of constipation
- slow-transit constipation
- slow movement from proximal to distal colon
- pelvic floor dysfunction
- medication
physical exam for constipation should include
- anal reflex: anal “wink” -> as finger touches anus, it closes
- DRE
- pelvic exam: evaluate for rectocele -> evidence of pelvic floor dysfunction
managment of constipation
- increase activity/exercise
- increase fiber to 20-30g/d
- minimize laxative use
complications of constipation
- fecal impaction
- large bowel obstruction
differentiate betwee acute and chronic diarrhea
- acute: < or = 14 days in duration
- chronic: > 30 days in duration
most common etiology of acute diarrhea
-
viral
- rotavirus, adenovirus, norwalk-like virus
- bacterial causes tend to be more severe
How does Noninflammatory diarrhea present
- diffuse, watery diarrhea with abdominal cramping, N/V and fever
list the pathogens that causes of Noninflammatory diarrhea
- norwalk-like virus
- rotavirus
- adenovirus
- Giardia
how does inflammatory diarrhea present
- fever and bloody diarrhea, LLQ pain and tenesmus
list pathogenic causes of inflammatory diarrhea
- shigella
- salmonella
- campylobacter
- enterohemorrhagic Ecoli
- C diff
list the red flags of diarrhea
- bloody diarrhea
- uncontrolled diarrhea
- passage of > or = 6 unformed stools in 24 hr
- fever
- dehydration
- elderly
- immunocompromised
List the stool studies
- fecal leukocytes
- ova and parasites
- done if symptoms > 7 d
- bacterial culture (salmonella, campylobacter, shigella)
- blood or fever
what lab test is done when assessing diarrhea in patients with a h/o travel or MSM
stool wet mount (r/o amebiasis)
what lab test is done when assessing diarrhea in patients with a h/o recent abx
- stool cytotoxicity assay for C-diff
what pathogen commonly causes viral gastroenteritis in children < 2 yo
rotavirus
transmission of campylobacter
- food borne ilness
campylobacter can increase risk of what condition
guillian-barre syndrome
tx for camplylobacter cause of acute diarrhea
erythromycin
how is shigella transmitted
- food
- water
- direct contact
tx of acute diarrhea caused by shigella
bactrim
clinical presentation
- bloody diarrhea
- abdominal pain
- no fever
- enterhemorrhagic ecoli O157:H7
what lab must you request when assessing for Ecoli O157:H7
stool culture for E coli O157:H7
Ecoli O157:H7 can cause what complication in children
- hemolytic uremic syndrome
hemolytic uremic syndrome presents in what triad
- acute renal failure
- mircoangiopathic hemolytic anemia
- thrombocytopenia
most significant risk factor of C-diff
- abx use within the past 3 months
C-diff produces a toxin that does what
- binds to epithelial lining of GI tract to form pseudomembranes
how is C-diff diagnosed
cytotoxicity assay
managment of C-diff
- stop offending abx
- avoid antimotiltiy agents to allow toxin to clear
- metronidazole
bloody diarrhea is most commonly associated with which pathogen
enterohemorrhagic Ecoli
noninflammatory diarrhea with vomiting suggests what condition
- viral enteritis
- food poisoning
