IBS/Coeliac Disease Flashcards
What is IBS?
irritable bowel syndrome
- condition affecting the intestines
- is abdominal pain/discomfort which may be associated with defecation with/without a change in bowel habits
What causes IBS?
causes are unclear - irregular muscle contractions (peristalsis) in the intestinal wall - nervous system abnormalities (innervation of peristalsis) inflammation in the intestines severe infection hanges in gut microflora stress family history
Why is peristalsis painful with irritable bowel syndrome (IBS)?
typical process
- intestine squeezes contents along the small intestine and large intestine to anus via peristalsis
- usually is a painless process
in IBS, the intestine is sensitised
- therefore peristalsis is painful
What are symptoms of irritable bowel syndrome (IBS)?
are considered IBS if occurring for more than 6 months
cramping abdominal pain discomfort bloating flatulence constipation diarrhoea sense of incomplete defecation = is typically intermittent – a few times a week
passage of mucus (anus) nausea - red flag lethargy insomnia headaches back pains urinary incontinence
What are symptoms that you should be cautious against?
unintentional or unexplained weight loss
rectal bleed
family history of ovarian or bowel cancer
anaemia
blood tests show raised inflammatory markers
recently altered bowel habit in over 60s
What are questions you should ask when speaking to patients about IBS?
who what are the symptoms how long what action have been taken any medications
location of pain
- usually in the lower, left quadrant of abdomen
blood or mucus in stools
incontinence or urgency
lifestyle changes
- stress, diet, trigger foods
What are symptomatic treatments for IBS?
dietary advice
- healthy, balanced diet = try to avoid trigger foods
- keep a diary of their food intake to try to make a diet connection
regular exercise
avoid excessive alcohol, caffeine and fizzy drinks
reduce stress levels
How should a treatment for IBS be decided?
choose based on the predominate presenting symptoms
- abdominal pain
- diarrhoea
- constipation
What are treatments for IBS where abdominal pain predominates?
antispasmodics/smooth muscle relaxer
- mebeverine, alverine citrate
= directly relaxes intestinal smooth muscle (inhibits contraction), does not impact gut motility
= contraindicated in paralytic ileus
antimuscarinic
- hyoscine butyl bromide
= relief of spasm of the GI tract, reduces gut motility
= contraindicated in myasthenia gravis, megacolon
and narrow angle glaucoma
smooth muscle relaxer
- peppermint oil
= relaxes intestinal smooth muscle, relieves spasms and reduces gut motility
= contraindicated in inflammatory bowel disease, GI obstruction
What are treatments for IBS where constipation predominates?
bulk forming laxative
- fybogel (isphaghula hulk), stericulia
mode of action:
- retains water in gut
- increases faecal bulk
- stimulates peristalsis
side effects:
- bloating, distension, flatulence
What are treatments for IBS where diarrhoea predominates?
anti-motility drugs
- loperamide (Imodium)
reduces duration of diarrhoea and stool frequency
How do tricyclic antidepressants affect IBS?
TCAs
amitriptyline, imipramine, nortriptyline
- slow gastric transit so are beneficial in diarrhoea predominant IBS
dosage is typically much lower than that used for treating depression
What is Coeliac disease?
is an autoimmune condition
- the body recognises gliadin as a threat and makes antibodies
- damages the villi in small intestine, flattening them, disrupting the body’s ability to absorb nutrients
gluten is composed of two types of proteins, called gliadin and glutenin
coeliac disease is not anallergyor an intolerance to gluten
What are the symptoms of coeliac disease?
diarrhoea abdominal pain flatulence bloating indigestion constipation - can be misdiagnosed as IBS
weight loss/ tiredness/anemia/rash/peripheral neuropathy/oedema/ataxia
can result in malnutrition
- failure to grow/delayed puberty in children
What is the treatment for coeliac disease?
the only treatment for coeliac disease is a gluten free diet
- gluten is found in wheat, barley and rye
= pasta, bread, beer
