IBS Flashcards
Usually have abormality in 1 or more area
Visceral hypersensitivity
Alterations in intestinal microflora
Food sensitivity
Psych
Visceral hypersensitity leads to
Also have
Correlation w
Colonic distension produces
sx improve w
inc colonic motor activity w meals/rectal distenstion
inc peak amplitude of HAPCs
entry of food into cecum and pain
more pain than a normal indiv
fasting
Alterations in intestinal microflora
sx begin after
usually result of
may have SI bacterial overgrowth/rapid bowel trasnit
Gastroenteritis- campylobacter, salmonella, shigella
mucosal inflamm
Food hypersensitivity
usually result of
common, unidentified
carb malabsorption- fermentable oligo/di/monosaccharides enter colon, ferment, leading to sx
Psych
possible inc
most have problems- exaggerated response to stress- alters sensitivity threshold
activation of cingulate cortex (emotional system)
MC presenting pt
more common in
young women
women
CM
Sx that steer away from IBS
Chronic ab pain/altered bowel habits- IM/crampy, mild to severe
IM diarrhea, cons, both
anorexia, malnutrition, Wl, vomiting, pain w awakening
Dx
consider in pts w
lab tests
clinical features
recurrent ab pain >3 days/m
Sx > 3mths, onset 6m prior
Pain/discomfort improves w defecation
Onset w change in stool freq/form
CBC, electrolyes
Management
eds to target
Identify problem foods, remove and add back slowly
Helpful diet
reassurance, diet changes
Pain/discomfort/Cons/diarrhea
diary- gas producing (legumes/cabbage), frucose/sweetenrs (sorb/man/xylitol) lead to bloating/faltulence
eliminate FODMAPs= fructose (fruit), lactose (dairy), fructans (wheat, garlic, onion), galactans (beans/soy/lentil), polylos (sweetners, avocado, apricots, cherries)
Pharm agents for pain
Antispasmodics
Tricyclic AD
dicyclomine/hyoscyamine- short term- inhibit GI SM, reduce colonic motility
Prevention, 3-4 wks for effect
use predominantly in pt w diarrhea (worsens con)
Pharm agents for cons
Osmotic lax
Lubiprostone
Linaclotide
Tegaserod
Soluble fiber/osmotic lax, high fiber diet, dupplemet w psyllium/isaphulga
PEG (preff), lactulose, MoM
activates Cl channels, leading to fluid sec (only women age 18+)
GC agonist, inc fluid sec
5HT4 agonist, inc colonic motility (not in US)
Pharm agents for diarrhea
Second line
SE
Alosetron
Eluxadoline
Loperamide
Bile acid sequestrants (coles), prevent BA from stimulating colonic sec/motility
Bloating/flat/ab discomfort
5HT3 antag dec colonic motilty/sec
mu opiod receptor ag and delto opiod antag, dec viscera hypersenstivity
Dec motility- N/cons/ab pain
