IBS Flashcards
what are the symptoms irritable bowl syndrome
abdominal pain/ cramping that is often relieved by passing wind/ faeces
alternating diarrhoea and constipation
sensation of incomplete emptying
abdominal bloating
mucus in stool
nausea
what are thought to be the causes of it
genes + environment
disrupted GI motility (high amplitude propagating contractions- exaggerates gastro-colic reflex, pain)
visceral hypersensitivity
what are the two types of visceral hypersensitivity
peripheral sensitisation (inflammatory mediators up-regulate sensitivity of nociceptors terminals- 20% after infectious gastroenteritis), central sensitivity (increased sensitivity of spinal neurones- increased pain radiation to somatic structures
what criteria is used to diagnose IBS
rome III criteria
what illness are associated with IBS
fibromlyalgia, chronic fatigue syndrome, temporomandibular joint dysfunction, chronic pelvic pain, psychiatric problems
what are the additional symptoms of IBS
bloating, urgency, incomplete emptying, mucus per rectum, nocturea, aggravated by stress
what should be asked in a history of suspected IBS
bowel habit, bloating, nocturia, diet (bread, fibre, meal times, bizarre exclusions), trigger factors (infection, menstruation, drugs), opiate use (codeine and opiate/ narcotic bowl syndrome), physiological factors, underlying factors (cancer)
what investigations should be done
FBC, ESR (inflammatory activity)/ plasma viscosity, CRP, antibody testing coeliac disease (TTG), lower GI tests if over 50 or strong FH of CRC
what are the alarm features of cancer
- age more than 50
- short duration of features
- woken by altered bowel habit
- Rectal bleeding
- weight loss
- anaemia
- FH of colorectal cancer
- recent antibiotics
how is IBS managed
personal for each patient -regular meal times -reduce fibre -FODMAP/ GFD drugs -stop opiates -anti diarrhoeals -anti spasmodics -anti depressants
what do spasmodics do
relieve pain but dont help diarrhoea/ constipation
why should you reduce fibre
as it aggravates pain
what is opiate/ narcotic bowel syndrome
worsening pain control despite escalating dose, reliance on opiates, progression of frequency duration and intensity of pain, no GI explanation for pain
what anti diarrhoeals can be used and what are the pros and cons and how does it work
loperamide (tablets or syrup); opiate analogue that inhibits peristalsis and gut secretions.
benefits diarrhoea, no dependancy
has no effect on pain
use PRN/ prophylactic
name an antidepressant that can be used- and its pros
tricyclics e.g. amitriptyline
- reduce diarrhoea
- reduce afferent signals from gut
- helps restore sleep pattern
-low dose as side effects limit use
