IBS Flashcards

1
Q

what are the worrying signs of functional gut disorders (poor prognosis)?

A

patient in wheelchair due to pain
patient given up work due to pain
partner given up work to look after patient
patient wears dark glasses
patient carries water everywhere and drinks during interview

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2
Q

what is IBS?

A
chronic relapsing problem
abdo pain
bloating
change in bowel habit
10-20% population (peak in 30s-40s)
females>males
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3
Q

what is the pathophysiology of IBS?

A

genes + environment
disturbed GI motility; high amplitude propagating contractions - exaggerated by gastro-colic reflex, pain
visceral hypersensitivity

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4
Q

what is visceral hypersensitivity?

A

seen in 2/3rds patients
peripheral sensitisation
- inflammatory mediators up regulate sensitivity of nociceptor terminals
central sensitisation
- increased sensitivity of spinal neurones

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5
Q

how is peripher hypersensititvy evidenced?

A

up to 20% recall onset after infectious gastroenteritis

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6
Q

how is central hypersensitivity evidenced?

A

increased pain radiation

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7
Q

what is rome III criteria?

A

recurrent abdopain/discomfort for 3 days per month for 3 month + 2 or more of
- improvement/worse with defecation
- onset assoc with change stool frequency
onset assoc with change in stool form

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8
Q

what other clues can indicate IBS?

A

bloating
urgency
sensation of incomplete emptying

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9
Q

what illnesses is IBS associated with?

A
fibromyalgia
chronic fatigue
TMJ dysfunction
chronic pelvic pain
overlap causes more more sever IBS, psychiatric problems
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10
Q

how common is psychiatric problems in IBS?

A

50%

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11
Q

what is the best way to identify IBS?

A

history

  • bowel habit
  • bloating, nocturia
  • diet (bread, fibre, meal times)
  • trigger factors (infection, menstruation, drugs)
  • opiate use (codeine and opiate/narcotic bowel syndrome)
  • psychosocial factors (stress)
  • underlying fears (cancer)
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12
Q

what are the alarm features of IBS?

A
age >50
ahort duration of symptoms
woken from sleep
rectal bleeding
weight loss
anaemia
family history of colorectal cancer
recent antibiotics (potentially C diff caused)
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13
Q

what are the investigations for IBS?

A

FBC
ESR/ plasma viscosity
CRP
antibody testing for coeliac disease (TTG)
lower GI testing if >50 or strong family history of colorectal cancer

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14
Q

how is IBS managed?

A
diet
- regular meal times
- reduce fibre
- FODMAP/GFD
drugs
- stop opiates
- anti-diarrhoeals
- anti-spasmotics
- anti-depressants
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15
Q

what is the relationship between fibre and IBS?

A

suggestion that low fibre diet improves symptoms

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16
Q

what can prolonged use of opiates lead to?

A

opiate/narcotic bowel syndrome

can cause opiate induced pain

17
Q

name 2 anti-spasmodics

A

mebeverine

hyoscine

18
Q

what can aggrevate IBS?

A

fibre

lactose

19
Q

what laxative is usually used for IBS?

A

lactulose

20
Q

name an anti-diarrhoeal

A

loperamide

opiate analogue

21
Q

what are the benefits of amitriptyline?

A

reduce diarrhoea

reduce afferent signals from gut

22
Q

what psychological treatment can be offered for IBS?

A

if sever anxiety/depression
if no response to empiric anti-depressants
relaxation therapy
cognitive behavioural therapy

23
Q

what is the minimum number of relevant investigations?

A

few as possible to rule out sinister cause