IBS Flashcards
It is abdominal pain >6 months which is:
- relieved by defecation
OR - Associated with altered bowel habit 2 or more of TEnse Bum. What does the mnemonic stand for?
Tenesmus - a continual or recurrent inclination to evacuate the bowels, caused by a disorder of the rectum or other illness.
Exacerbated by eating (post-prandial)
Bloating
Urgency
Mucus PR
What may make it worse?
What can it lead to?
Stress
Menstruation
GE
Anxiety and depression
Red flags which suggest it is not IBS?
PR bleeding - you never get blood with IBS
Nocturnal symptoms
Weight loss
FH of bowel or ovarian cancer
> 55 yrs
Risk factors:
What sex is usually affected?
What age range is typically affected?
Female
20-40
How is a diagnosis made?
Excluding other causes
Investigations - if criteria met:
What would you see on examination that might suggest it is NOT IBS?
What bloods should be done? - 3
What can be done to differentiate between IBD and IBS?
Abdominal or rectal masses
FBC
CRP/ESR
Coeliac antibodies
Faecal calprotectin
Investigations:
When might further tests be needed?
What further tests should be done? - 4
What test can be done for ovarian cancer?
If the patient doesn’t fit the normal IBS criteria.
Imaging
TFT’s
Hydrogen breath test - H.pylori
FOB - faecal occult blood (FOB) test detects small amounts of blood in your faeces, which you would not normally see or be aware of.
CA 125 is a protein often found on the surface of ovarian cancer cells and in some normal tissues. It is used as a marker for ovarian cancer.
Management:
Dietary:
- meals
- fluids
- alcohol
- tea/coffee
- fruits
- fibre
Regular meals Good hydration (8 cups per day)
Reduce alc
Max 3 cups of tea/coffee per day
Max 3 fruit portion per day
AVOID too much fibre especially if insoluble
Encourage soluble fibre
Management:
What dietary change can be recommended if the symptoms persist?
One lifestyle change?
Low FODMAP diet
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are short-chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating.
MORE EXERCISE
Management:
What type of med can be given for the bloating?
What med should be given for the D?
What can be given for constipation?
What med can be given to reduce dyspepsia that also has prokinetic and antiemetic effects?
Antimuscarinic - Mebeverine
Loperamide
Laxatives - ispaghula husk, senna or docusate
Anti-emetic - Metoclopramide
Management - the cause can sometimes be psychiatric
What should be done if there has been no response to drug therapy?
CBT
Antidepressents - TCAs, SSRIs etc.
