IBS Flashcards
epidemiology of IBS
young age <45
female
family hx
mental health problems
describe IBS
most common functional GI disorder (FGID)
mixed group of abdominal symptoms for at least 6 months where no organic cause can be found
symptoms of IBS
abnormal stool frequency abnormal stool form abnormal stool passage passing of mucus bloating or feeling of abdominal distension includes non-intestinal symptoms
non-intestinal symptoms of IBS
gynaecological urinary back pain headaches bad breath poor sleeping fatigue fibromyalgia temperomandibular joint dysfunction
gynaecological symptoms of IBS
dysmenorrhoea
dyspareunia
premenstrual tension
urinary symptoms of IBS
frequency
urgency
nocturia
incomplete emptying of bladder
biopsychosocial conceptualisation of pathogenesis and clinical expression of FGID
disorders of intestinal motility or enhanced visceral perception via; early life (genetics and environment) physiology (motility and sensation) psychological factors (life events, psychological state)
triggers of IBS
GI infection/malabsorption/travel antibiotic therapy pelvic surgery psychological stress and trauma mood disturbances - anxiety and depression food intolerance
diagnosing criteria for IBS
Rome II
describe Rome II
in last 12 months there should be at east 12 consecutive weeks of abdominal discomfort with 2/3;
relieved by defecation
onset associated with change in frequency of stool
onset associated with change in form of stool
what is meant by abnormal stool frequency
<3 a week
>3 a day
what is meant by abnormal stool form
lumpy/hard
loose/watery
what is meant by abnormal stool passage
striating
urgency
feeling of incomplete evacuation
red flags for IBS
rectal bleeding
nocturnal pain
fever
weight loss
management for IBS - constipation
targeting central and end-organ therapies
5-HT4 receptos agonists
selective C-2 chloride channel activators
guanylatel cyclase agonist
end organ treatment for IBS
explore dietary triggers
high fibre diet (for constipation)
anti-diarrhoea drugs for bowel frequency
smooth muscle relaxants for pain
central treatment for IBS
physiological explanation and symptoms psychotherapy hypnotherapy cognitive behavioural therapy antidepressants
anti-diarrhoea drugs
loperamide
codeine phosphate
co-phenotrope
smooth muscle relaxants drugs
mebeverine hydrochloride
dicycloverine hydrochloride
alverine citrate
peppermint oil
antidepressants in IBS
nortriptyline - diarrhoea
paroxetine - constipation
criteria for examining stool
bristol stool chart
tests for IBS
stool culture
upper GI endoscopy
5-HT4 receptor agonists
prucalopride
5-HT4 mechanisms of action
stimulates enteric nervous system
increases peristalsis
alleged analgesic effect
management of IBS - diarrhoea
targeting central and end-organ therapies
5-HT3 receptor antagonists
selective C-2 chloride channel activators
lubiprostone
selective C-2 chloride channel activators mechanisms of action
bicyclic fatty acid derived from prostaglandin E
chloride-rich secretion
soften stool, increase motility and promote SBMs
guanylate cyclase agonist
linaclotide
guanylate cyclase agonist mechanisms of action
peptide agonist of guanylate cyclase 2C
increases intracellular cyclic GMP
increased intestinal secretion and transit
reduces abdominal pain
loperamide mechanisms of action
reduces stool frequency
improves consistency
describe codeine phosphate
effective but should be avoided (patient becomes dependent)
5-HT3 receptor antagonists
alosetron
5-HT3 receptor antagonists mechanisms of action
improved stool form
reduced frequency and less bloating
reduced pain
