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Exam 3 > IBS And Diverticula > Flashcards

IBS And Diverticula Flashcards

1
Q

What is diagnostic criteria for IBS called?

A

Rome IV

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2
Q

What are components of Rome IV criteria

A

Recurrent abdominal pain at least 1 day pew week in the past 3 months with 2 or more of:

Changes with defecation
Associated with change in freq of stool
Associated with change in form or appearance

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3
Q

IBS in more common in this population

A

Young people

Females

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4
Q

Symptoms of IBS

A

Abdominal pain or discomfort
Constipation/ diarrhea
Bloating /dissension
Non colonic symptoms like dyspepsia, GERD, Nausea

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5
Q

What are the subtypes of IBS?

A

IBS-C
IBS-D
IBS-M
IBS-U

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6
Q

What is the threshold for classifying IBS?

A

25% of Bowel Movements in a category

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7
Q

Non-colonic symptoms of IBS

A

Nausea, dyspepsia, GERD

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8
Q

How long are IBS going on before diagnosis? What can you rule out?

A

3 to 6 months

Rule out: pregnancy, food poisoning, dietary indiscretion

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9
Q

What are diverticula?

A

Sac-like protrusion owns of the colonic wall

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10
Q

Diverticulosis vs. diverticulitis

A

Osis- refers to presence of diverticula

Itis- inflammation of diverticulum

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11
Q

IBS puts patient at an increased risk for what three surgical procedures?

A

Cholecystectomy
Appendectomy
Hysterectomy

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12
Q

Abdominal motility in IBS includes what?

A

Diarrhea (high amp propulsive contractions, enhanced gastro-colic response, rectal hypersensitivity)

Constipation (decreased HAPC, increased segmental contractions, decreased rectal sensitivity

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13
Q

IBS hypersensitivity includes what?

A

Low level distension causes pain
Visceral pain, not somatic
Increased cerebral cortex activity

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14
Q

Markers of inflammation in IBS

A 
Lymphocytes 
Mast cells (activated next to colonic nerves in abd pain)
Proinflammatory cytokines (elevated interleukin and TNF)
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15
Q

There is a 5x higher incidence of IBS in which situation?

A

Post-infection post-inflammatory state

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16
Q

What kind of food sensitivity is involved in IBS?

A 
Food allergy (food high in IgG)
Carb malabsorption (fermentable FODMAP foods)
Gluten sensitive
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17
Q

When diagnosis IBS, you should always test for and rule out ______ _______

A

Celiac disease

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18
Q

Alarming IBS features

A 
Bloody stool
Fever
Night poops
Weight loss
Family history of other diseases
Onset after 50 yo
Travel to parasitic countries
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19
Q

What lab tests do you want to order to confirm IBS-D?

A

Stool culture or O&P r/o infection

Celiac disease panel r/o celiac

Fecal calprotectin or CRP r/o IBD

Colonoscopy r/o microscopic colitis

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20
Q

What lab tests do you want to order to confirm the diagnosis of IBS-C?

A 
Radiography
Colonoscopy (structural lesions)
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21
Q

IBS differential- infection

A

Giardia
Ameba
Bacterial SI overgrowth

22
Q

IBS differential- IBD

A

Ulcerative colitis
Crohn’s
Microscopic colitis

23
Q

IBS differential- malabsorption

A

Celiac
Pancreatic disease
Post-surgical

24
Q

IBS differential- Psychological

A

Anxiety
Pain
Depression
Somatization

25
Q

IBS differential- dietary factors

A 
Lactose
Sorbitol
Fructose
Caffeine
Alcohol
Fat
Gas producing foods
26
Q

IBS diet

A

Fiber- soluble fiber
No lactose
Low FODMAP diet

27
Q

What is in FODMAP? What is low FODMAP diet?

A 
Fructans
Galatans
Lactose
Fructose
Sorbitol
Xylitol
Mannitol

Diet includes high meat low carb usually

28
Q

Medications for IBS-D

Indicate first line and second line

A

First line: opioid agonist like loperamide ppx
Second line: bile salt sequestering agents

Also try:
Mixed opioid agonist/antagonist: eluxadoline
5-HT3 Antagonist: Alosetron (limited in US)

29
Q

Medications for IBS-C

A 
Osmotic laxatives (Miralax)- bloat, pain
Stimulant laxatives (Dulcolax)- cramping
Lubiprostone (amitiza)- activates Cl channels to draw fluid
Linaclotide (if laxatives fail) guanylate Cyclase agonist
30
Q

IBS medications for pain management

A

Antispasmodics and anticholinergics
Smooth muscle relaxants
Antidepressants (TCAs and SSRIs)

31
Q

Why give rifaximin for IBS?

A

Its non-absorbable, so stays in gut only

Improves in the setting of no constipation
Improvement in bloating, abdominal pain, altered bowel habits

32
Q

Peppermint oil can be used in IBS for

A

Pain, diarrhea, flatulence, distension

33
Q

IBS bloating

First and second steps?

A

First: adjust diet, treat constipation

Second: probiotic, abx, TCA, SSRI

34
Q

IBS constipation first and second step?

A

First: fiber supplement, polyethylene glycol laxative
Second: lubiprostone, linaclotide

35
Q

IBS diarrhea first and second steps for treatment

A

First: loperamide
Second: 5HT3 antagonist (alosetron)

36
Q

IBS abdominal pain management first and second steps

A

First: antispasmodic, peppermint oil
Second: TCA, SSRI, psych therapy

37
Q

Diverticula disease prevalence

A

Higher with increasing age

Western nations: left side
Asia: right side

38
Q

Predisposing dietary factors for Diverticulosis

A 
Low fiber
High fat
High red meat
Low fruit veggies
Obese
Sedentary lifestyle
39
Q

Diverticular disease pathophysiology

A

There is a point of weakness, decrease resistance of the wall to intravascular-luminal pressure, increased pressure causes herniation in the mucosa

40
Q

In diverticular bleeding, the blood vessel is separated from the bowel ______ by _______. Over time, the vessel wall is exposed to injury, leading to weakness and predisposing _________.

A

Lumen, mucosa, rupture

41
Q

Clinical manifestations of diverticulitis

A 
LLQ pain
Few days, previous episodes
N/V
Changed bowel habits
Urinary symptoms
Labs show mild leukocytosis
Low grade fever
42
Q

What kind of imaging do you order for Diverticulitis?

A

CT scan with PO and IV contrast

43
Q

What do I see on diverticulitis imaging?

A

Increased soft tissue density in pericolic fat

Bowel wall thickening

Phlegmon/abscess

44
Q

What makes diverticulitis complicated?

A

Perforation
Obstruction
Fistula
Abscess

45
Q

How do you treat uncomplicated diverticulitis?

A

7-10 days antibiotics

Quinolone + metro
Amoxicillin-clavulante
Bactrim + metro

46
Q

How do you treat complicated diverticulitis?

A

IV antibiotics, then PO for following 10-14 days

Amp-sulbactam
Pip-tazo
Ticarcillin/clavulante

Ceftriaxone+metro

47
Q

I have diverticulitis- what should my diet look like?

A

NPO
Clear liquids
High fiber diet after resolution

Seeds and nuts are OK

48
Q

Clinical presentation of a diverticular bleed

A

Painless rectal bleeding

Shock in extreme cases
Mild cramps
Normal abdominal exam

49
Q

What is the most common cause of a lower GI bleed?

A

Diverticulitis

50
Q

Patient is presenting with bright red stool per rectum. What are my first two steps?

A

Rule out UGI bleed with EGD then assume it is coming from colon

51
Q

Diverticula bleed treatment

A

Resuscitation (IV blood products prn)
Endoscopic visualization to localize and clip

Most heal on own

Exam 3 (18 decks)

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