IBS

Question 1

What structural changes are there in the bowel?

Answer 1

None

Question 2

Pre-disposing factors

Answer 2

Females 
Mid teens - late 20's 
Genetics 
Environment 
Stress
Diet 
Medication

Question 3

Pathophysiology

Answer 3

Exaggerated nervous response - eat something then need to relieve bowels 5 mins later

Visceral hypersensitivity - increase in pain sensation experienced by internal organs

Question 4

Clinical presentation

Answer 4

Abdominal pain 
Bloating 
Diarrhoea
Urgency
Tenesmus 
Mucous PR 
Flatulence

Question 5

Alarming features

think its something more serious than IBS

Answer 5

Age: >50
Weight loss
PR bleeding 
Woken up from sleep with symptoms 
Sudden onset
Anaemia 
FHx colorectal cancer 
Recent antibiotics

Question 6

Criteria for diagnosis

Answer 6

Abdominal pain for at least 3 days per month for 3 months + 2 or more of:

• change in stool appearance
• improvement with defecation
• increased stool frequency

Question 7

Investigations

Answer 7

Bloods - FBC, CRP (normal)
Screen for coeliac disease (TTG)
If any alarm symptoms present - colonoscopy

Question 8

Associated conditions

Answer 8

TMJ dysfunction
Fibromyalgia
Chronic fatigue syndrome

Question 9

Management

Answer 9

Diet: 
- regular meal times, smaller meals, reduce fibre 
Drugs: (symptomatic) 
- anti spasmodics
- anti diarrhoeals
- anti depressants

Question 10

Anti spasmodics

Answer 10

Relieve stomach cramps
Buscopan
- anti muscarinic
- relax gut by reducing parasympathetic flow

Peppermint oil
- smooth muscle relaxant

Question 11

Anti diarrhoeals

Answer 11

Reduce diarrhoea
No effect on pain

Loperamide

• anti motility drug which inhibits peristalsis
• use PRN

Question 12

Anti depressants

Answer 12

Give in low doses to reduce pain perception

Reduces diarrhoea