IBS

Question 1

epidemiology of IBS

Answer 1

young age <45
female
family hx
mental health problems

Question 2

describe IBS

Answer 2

most common functional GI disorder (FGID)

mixed group of abdominal symptoms for at least 6 months where no organic cause can be found

Question 3

symptoms of IBS

Answer 3

abnormal stool frequency 
abnormal stool form
abnormal stool passage 
passing of mucus
bloating or feeling of abdominal distension 
includes non-intestinal symptoms

Question 4

non-intestinal symptoms of IBS

Answer 4

gynaecological
urinary
back pain 
headaches
bad breath 
poor sleeping 
fatigue 
fibromyalgia
temperomandibular joint dysfunction

Question 5

gynaecological symptoms of IBS

Answer 5

dysmenorrhoea
dyspareunia
premenstrual tension

Question 6

urinary symptoms of IBS

Answer 6

frequency
urgency
nocturia
incomplete emptying of bladder

Question 7

biopsychosocial conceptualisation of pathogenesis and clinical expression of FGID

Answer 7

disorders of intestinal motility or enhanced visceral perception via;
early life (genetics and environment)
physiology (motility and sensation)
psychological factors (life events, psychological state)

Question 8

triggers of IBS

Answer 8

GI infection/malabsorption/travel
antibiotic therapy 
pelvic surgery 
psychological stress and trauma 
mood disturbances - anxiety and depression 
food intolerance

Question 9

diagnosing criteria for IBS

Answer 9

Rome II

Question 10

describe Rome II

Answer 10

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

Question 11

what is meant by abnormal stool frequency

Answer 11

<3 a week

>3 a day

Question 12

what is meant by abnormal stool form

Answer 12

lumpy/hard

loose/watery

Question 13

what is meant by abnormal stool passage

Answer 13

striating
urgency
feeling of incomplete evacuation

Question 14

red flags for IBS

Answer 14

rectal bleeding
nocturnal pain
fever
weight loss

Question 15

management for IBS - constipation

Answer 15

targeting central and end-organ therapies
5-HT4 receptos agonists
selective C-2 chloride channel activators
guanylatel cyclase agonist

Question 16

end organ treatment for IBS

Answer 16

explore dietary triggers
high fibre diet (for constipation)
anti-diarrhoea drugs for bowel frequency
smooth muscle relaxants for pain

Question 17

central treatment for IBS

Answer 17

physiological explanation and symptoms 
psychotherapy 
hypnotherapy 
cognitive behavioural therapy
antidepressants

Question 18

anti-diarrhoea drugs

Answer 18

loperamide
codeine phosphate
co-phenotrope

Question 19

smooth muscle relaxants drugs

Answer 19

mebeverine hydrochloride
dicycloverine hydrochloride
alverine citrate
peppermint oil

Question 20

antidepressants in IBS

Answer 20

nortriptyline - diarrhoea

paroxetine - constipation

Question 21

criteria for examining stool

Answer 21

bristol stool chart

Question 22

tests for IBS

Answer 22

stool culture

upper GI endoscopy

Question 23

5-HT4 receptor agonists

Answer 23

prucalopride

Question 24

5-HT4 mechanisms of action

Answer 24

stimulates enteric nervous system
increases peristalsis
alleged analgesic effect

Question 25

management of IBS - diarrhoea

Answer 25

targeting central and end-organ therapies

5-HT3 receptor antagonists

Question 26

selective C-2 chloride channel activators

Answer 26

lubiprostone

Question 27

selective C-2 chloride channel activators mechanisms of action

Answer 27

bicyclic fatty acid derived from prostaglandin E
chloride-rich secretion
soften stool, increase motility and promote SBMs

Question 28

guanylate cyclase agonist

Answer 28

linaclotide

Question 29

guanylate cyclase agonist mechanisms of action

Answer 29

peptide agonist of guanylate cyclase 2C
increases intracellular cyclic GMP
increased intestinal secretion and transit
reduces abdominal pain

Question 30

loperamide mechanisms of action

Answer 30

reduces stool frequency

improves consistency

Question 31

describe codeine phosphate

Answer 31

effective but should be avoided (patient becomes dependent)

Question 32

5-HT3 receptor antagonists

Answer 32

alosetron

Question 33

5-HT3 receptor antagonists mechanisms of action

Answer 33

improved stool form
reduced frequency and less bloating
reduced pain