IBS Flashcards
causes?
genes, and environment
visceral hypersensitivity
what are the two mechanisms of visceral hypersensitivity
Peripheral sensitisation: Inflammatory mediators up-regulate sensitivity of nociceptor terminals
Central sensitisation:
Increased sensitivity of spinal neurones
have to have Recurrent abdo pain/discomfort for at least __ days per month for __ months
Recurrent abdo pain/discomfort for at least 3 days per month for 3 months
must have 2 or more of which criteria?
Improvement with defecation
Onset assoc. with ∆ stool frequency or
∆ stool form (appearance) (diarrhoea or constipation)
what other symptoms are involved in IBS
and there are ≥2 of: urgency; incomplete evacuation; abdominal bloating/distension; mucous PR; worsening of symptoms after food.
what other illnesses are associated with IBS?
- fibromyalgia
- chronic fatigue
- temporomandibular joint dysfunction
- chronic pelvic pain
what is fibromyalgia
a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized tenderness at specific points on the body.
At least 50% of IBS patients are _____/_____/_____
At least 50% are depressed / anxious /hypochondriacal
what to ask about in the history ? 6
- Bowel habit
- Bloating, nocturia
- Diet
- Trigger factors
- Opiate use
- Psychological factors
what are you worried about with this history ?
cancer
what are some alarm features in a history ? 8
- Age > 50
- Short duration of symptoms
- Woken from sleep by altered - bowel habit
- Rectal bleeding
- Weight loss
- Anaemia
- FH of colorectal cancer
- Recent antibiotics
what may be some triggers factors for IBS? 3
infection, menstruation, drugs
what investigations would you do? 5
- FBC
- ESR/plasma viscosity
- CRP
- Antibody testing for coeliac disease (antiTTg
- Lower GI tests in > 50 or strong FH of CRC
what aspects of the diet might you suggest to improve symptoms
- regular meal times
- reduce fibre
- avoid tea, coffee and sorbitol
which fibres are bad?
insoluble ones - like in bran
what drugs would you want to stop if the patient is on it?
opiate analgesics
what are the classes of drug treatment for IBS? 4
- anti-diarrhoeals
- anti-spasmodics
- anti-depressants
- laxatives
give an example of an anti- diarrhoeal?
loperamide- opiate analogue
give two examples of antispasmodics
meberevine, hyoscine
what do anti-spasmodics do?
help with abdo pain - not diarhoea/constipation
give an example of an antidepressant
Tricyclics e.g. amitriptyline
what are the functions of tricyclics?
- Reduce diarrhoea
- Reduce afferent signals from the gut
- Helps restore sleep pattern
