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Foundations-GI > IBS > Flashcards

IBS Flashcards

1
Q

What age does IBS MCly occur in?

A

18-34 y.o.

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2
Q

What is imperative to screen for in IBS?

A
  1. Depression
  2. Suicidal ideation

*Psychiatric disease can co-exist with IBS

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3
Q

What can look exactly like IBS? What should you screen the pt for to rule this out?

A

Celiac Disease

IgA TTG or celiac panel

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4
Q

What is a Traditional IBS diet

A
  1. Regular meal pattern
  2. Avoidance of large meals
  3. Reduced intake of: fat, insoluble fibers, caffeine, gas-producing foods (beans, cabbage, onion)
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5
Q

What can you consider in patients with mild and intermittent sx’s?

A

Lifestyle & diet modification:

  1. IBS diet
  2. Exlcusion of gas-producing foods
  3. Avoid lactose and/or gluten
  4. Fiber/psyllium: Citrucel, Metamucil
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6
Q

IBS with predominant constipation (IBS-C) pharmacology treatment

A
  1. Osmotic laxatives: Miralax (polyethylene glycol)

2. Lubiproston: Local acting chloride channel activator

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7
Q

What is first line treatment in IBS with predominant diarrhea (IBS-D)

A
  1. Antidiarrheal agents: Loperamide (Imodium)
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8
Q

What can you consider in pt’s with IBS-D post cholecystectomy?

A

Bile Acid Sequestrants

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9
Q

Treatment for abdominal pain and bloating in IBS?

A

Antispasmodics:

  1. Diclyomine
  2. Hyoscyamine
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10
Q

What Antidepressant can you consider in IBS-D who have failed other treatments?

A

TCA’s

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11
Q

What Antidepressant can you consider in IBS-C who have failed other treatments?

A

SSRI’s: Sertraline (Zoloft)

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12
Q

What can you consider in pt’s with IBS WITHOUT constipation AND with significant bloating?

A

Abx: Rifaximin

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13
Q

What makes a significant improvement in a pt’s prognosis with IBS?

A

Positive patient-provider relationship

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14
Q

What is the MC digestive complaint in the vernal population?

A

Constipation

F>M

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15
Q

How can you differentiate constipation from IBS-C?

A

NO PAIN

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16
Q

Constipation etiology

A
  1. Slow-transit constipation
  2. Pelvic Floor dysfunction
  3. Mediations: Opioids
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17
Q

In refractory pt’s with constipation, what diagnostic studies can you consider?

A
  1. Colonic Transit Study: Rate of radiopaque marker moving through the colon
  2. Anorectal manometry: Sphincter pressure
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18
Q

What laxatives can you consider in constipation?

A
  1. Osmotic laxatives: PEG (Miralax)
  2. Saline: Milk of Magnesium
  3. Emollient: colic
  4. Stimulant: Senokot
  5. Stimulant + Emollient: Peri-colace
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19
Q

What can fecal impaction lead to?

A

Large bowel obstruction

20
Q

Define Acute Diarrhea

21
Q

Define Persistent Diarrhea

A

> 14 days, but <30 days

22
Q

Define Chronic Diarrhea

23
Q

What is the leading cause of childhood death?

A

Acute diarrhea

24
Q

What is the MCC for acute diarrhea?

A

Viral:

  1. Rotavirus
  2. Adenovirus
  3. Norwalk-like virus
25
Q

Inflammatory diarrhea etiology

A

Bacterial:

  1. Campylobacter
  2. Salmonella
  3. Shigella
  4. Enterohemorrhagic E coli
26
Q

What is the MC protozoa etiology in diarrhea?

27
Q

Define non-inflammatory acute diarrhea

A
  1. Diffuse, watery diarrhea
  2. Abdominal cramping
  3. N/V
  4. Fever
28
Q

Non-inflammatory acute diarrhea causes

A
  1. Giardia
  2. Norwalk-like virus
  3. Adenovirus
29
Q

Define Inflammatory acute diarrhea

A
  1. Bloody diarrhea
  2. LLQ pain
  3. Tenesmus
30
Q

What is blood diarrhea MCly associated with?

A

Enterohemorrhagic E coli

31
Q

What is an important cause of viral gastroenteritis in children <2, but can also infect adults?

32
Q

What does Noninflammatory diarrhea with vomiting suggest?

A

viral enteritis

food poisoning

33
Q

What does Proctitis and rectal discharge suggest?

A
  1. Gonorrhea

2. LGV: lymphogranuloma venereum (unique strain of chlamydia)

34
Q

What is the main E.coli strain in the US in Enterohemorrhagic E coli?

A

E.coli O157:H7

35
Q

What is Enterohemorrhagic E coli associated with?

A

Hemolytic Uremic Syndrome:

  1. Hemolytic anemia
  2. Renal failure
  3. Thrombocytopenia
36
Q

Enterohemorrhagic E coli (EHEC) clinical presentation

A
  1. NO fever
  2. Bloody stool
  3. Abd tenderness
37
Q

Giardia classic sx’s

A
  1. Persistent diarrhea >7 days
  2. Fatty stools
  3. Contaminated water hx=camping
38
Q

If you suspect EHEC, what test must you order?

A
  1. Culture for E.coli O157:H7 2. Stool test for Shiga toxin
39
Q

If C. diff is suspected, what must you order?

A

Stool for C. diff toxin

40
Q

If Giardia is suspected, what must you order?

A

Stool for Giardia Ag (antigen)

41
Q

What is the most important priority in treating pt’s with acute diarrhea?

A

Rehydration!

42
Q

List symptomatic treatment options in acute diarrhea

A
  1. Loperamide: Imodium

2. Bismuth Subsalicylate: Pepto-Bismol

43
Q

Who should you avoid giving Loperamide (Imodium) to? Why?

A

Pt’s with suspected inflammatory disorder

May facilitate HUS in pt’s with EHEC

44
Q

What must you complete first before starting empiric abx?

A

Stool testing

45
Q

Who are you going to consider abx in?

A
  1. Benefits>risk
  2. Pt @ risk for complication: immunocompromised
  3. Mod/Severe diarrhea suspicious for inflammatory diarrhea, BUT EHEC or C.diff NOT suspected
46
Q

List the empiric abx in the treatment of acute diarrhea

A

Ciprofloxacin OR
Azithromycin
x3-5 day s

Foundations-GI (7 decks)

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