IBS Flashcards
What are the worrying signs of functional gut disorders?
In wheelchair due to pain Given up work due to pain Partner has giving up work to look after patient Wears dark glasses Drinks bottle of water during interview
What is IBS?
Chronic relapsing problem Abdominal pain Bloating Change in bowel habits 10-20% of population Females>Males
What is the pathophysiology of IBS?
Genes + Enviroment Disturbed GI motility High-amplitude propagating contractions Exaggerated gastro-colic reflex Pain Visceral hypersensitivity
What is visceral hypersensitivity?
Seen in 2/3rds of patients
Peripheral sensitisation - inflammatory mediators up-regulate sensitivity of nociceptor teminals
Central sensitisation - increased sensitivity of spinal neurones
What is the evidence for visceral hypersensitivity?
Peripheral - 20% recall onset after infectious gastroenteritis
Central - increased pain radiation
what is Rome III?
Recurrent abdo pain for 3 days per month for 3 months
Improves with defecation
Onset associated with stool frequency and form
What are other IBS clues and associated syndromes?
Bloating Urgency Sensation of incomplete emptying Fibromyalgia Chronic fatigue syndrome Temporomandibular joint disfunction Chronic pelvic pain
What percentage of IBS patients are depressed?
Around 50%
What features of the history indicate IBS?
Bowel habit Bloating Nocturia Diet Trigger factors Opiate use Psychological factors Underlying fears
What are alarm features of the symptoms of IBS?
>50 short duration of symptoms Woken from sleep Rectal bleeding Weight loss Anaemia Family history of colorectal cancer Recent antibiotics
What are the investigations for IBS?
BFC ESR / PLasma viscosity CRP Antibody testing Lower GI testing if >50 or family history
What is the treatment of IBS?
Diet - regular mealtimes, reduce fibre, Fodmap/GFD Drugs - stop opiate analgesia Anti-diarrhoeas Anti-spasmodics Anti-depressants
what can prolonged opiate use lead to?
Opiate/narcotic bowel syndrome
Can cause opiate induced pain
