IBS & constipation Flashcards
criteria for constipation
ROME criteria– 2+ is positive
* straining a lot
* lumpy or hard stools
* incomplete evacuation
* anorectal blockage
* manual maneuvers
* under 3 defecations/wk
normal vs slow vs outlet delay severe idiopathic chronic constipation
- normal transit: under 68 hrs is normal or 2.8 day
- slow: no increase in motor function after meals or to stimulation or over 5 hinton markers
- outlet delay: normal transit through colon but slows at rectum
which type of constipation suggests anorectal dysfunction and 3 conditions where its seen
outlet delay
- mega-rectum/impaction
- hirschsprung dz– no smooth muscle relaxation
- dyssynergic defecation
failure of relaxation or inappropriate contraction causing narrowed anorectal angle & an increase in anal canal pressure; can be conscious or unconscious
dyssynergic defecation
abnormal dilation of colon that is not caused by mechanical obstruction
Megacolon
6 classes of meds that can cause constipation
- narcotics
- CCB
- antidepressants
- antipsychotics
- diuretics
- anticonvulsants
4 neuro disorders & 4 systemic/metabolic disorders associated with constipation
- neuro– MS, parkinsons, stroke, SCI
- systemic/metabolic– hypothyroid, DM, scleroderma, amyloidosis
5 red flag sx of constipation
- fever, wt loss
- blood in stool to the point that water is red
- anemia
- fam h.o
- waking up d/t pain or needing poop
diagnostic tool to evaluate for outlet delay? if thats normal whats next?
anal rectal manometry. if normal then colonic transit study w/ radiopaque markers
good for kids w/ severe constipation or adults w/ anorectal dysfunction
watch EMG activity and modify responses
biofeedback
- Used for solid immobile stool in rectum
- manual, mineral oil enema, gastrografin enema
disimpaction
when is surgical subtotal colectomy used (2)? when is it not used (1)?
severe sx
colonic inertia
NOT for pelvic floor dysfunction
- absorbs water and increases fecal mass which can lead to increased frequency and softer stools
- SE: gas, bloating
- C/I: bowel obstruction
bulk forming laxative
(methylcellulose, psyllium, polycarbophil)
- Lowers surface tension of stool so water can easily enter→ softens stools
- Often used in combo w/ bulk forming laxatives
- SE: contact dermatitis, diarrhea, cramping
what is this & what are the 3 CI?
docusate sodium
* if concerned for bowel obstruction
* acute abdomen
* appendicitis
Increase intestinal water secretions→ increased stool frequency
* caution– electrolyte distrubaces in renal & cardiac dysfunction
* caution in elderly
osmotic agents (polyethylene glycol, Mg citrate, glycerin)
Alters electrolyte transport through intestinal mucosa→ increases intestinal motility
ok for long term
C/I: acute abdomen, GI obstruction/perforation, toxic megacolon
SE: melanosis coli, cramping, low K+ (salt overload)
stimulants (senna, bisacodyl)
- Increases intestinal fluid secretion & motility
- Best for severe constipation when other things failed
- C/I: severe diarrhea, liver impairment, obstruction
lubiprostone
Stimulates intestinal fluid secretion & transit; Minimally absorbed peptide agonist of guanylate cyclase-C receptor
* CI: Under 18 y.o; Concern for obstruction
* SE: Diarrhea, Abdominal pain, bloating
linaclotide
symptoms of abdominal pain or discomfort and associated with disturbed defecation
NO structural abnormalities
IBS
ROME Criteria for IBS
Recurrent abdominal pain or discomfort 1day/wk in last 3 months w/ 2+ of:
1. related to defecation
2. associated w/ change in frequency
3. or form of stool
- Abdominal tenderness
- Abnormal stool passage – incomplete evacuation or rectal dissatisfaction
- Passage of mucous
- Abdominal bloating with distention
- Sensation of distention
- Sexual dysfunction
- Dysmenorrhea
- Increased urination
- Body aches and pains
extraintestinal sx of IBS
4 types of IBS
- IBS-D
- IBS-C
- IBS-M
- IBS-unclassified
3 tests for IBS
CBC
stool hemoccult
colonscopy if patient is over 50
if sx warrant, what are 5 tests you could do
- serum chemistries
- albumin
- stool ova and parasites, Giardia
- TTG IgA and serum IgA
- Fecal calprotectin or fecal lactoferrin
3 elements of IBS pathophys
hypersensitivity, altered gut activity, dysregulation
risk for post-infectious IBS (9)
- young female
- smoker
- Prolonged fever
- Severe diarrheal illness
- Weight loss of ≥ 10 lbs. during diarrheal illness
- Bloody diarrhea
- Pre-existing anxiety or depression, History of stress
- antibiotics hx
- Sleep disturbance
psychosocial factors that affect IBS
abuse, stressful life events
dietary tx of IBS
LOW FODMAPS for 2 wks
gluten reduction/avoidance for 4-6 wks (avoid wheat, barley and rye)
- anticholinergic properties causing selective inhibition of GI smooth muscle which reduces the intestinal motility and spasm
- best if used intermittently to reduce pain and bloating
- caution in elderly, CHF, CAD, renal/hepatic impairment, risk of obstruction, glaucoma
what is this? what are some SE (5)
antispasmodic agents (dicyclomine and hyoscyamine)
SE: xerostomia, dry eye, UA retention, constipation, sleepiness
great for global IBS sx
caution w/ abrupt withdrawl, eldely, pregnant, DM, etc
SE: Na, HA, insomnia, nervousness, anxiety, drowsiness
antidepressants (TCA or SSRI)
Slow stool transit time and frequency by binding gut wall opioid receptors and inhibiting peristalsis
- no effect on discomfort or pain
C/I: no diarrhea, bloody diarrhea, UC, under 2, pseudomembranous colitis
SE: cramping, nausea, dizziness, etc
loperamide & lomotil (antidiarrheal agents)
antibiotic for IBS-D NOT for C. diff, child-pugh, possible fetal harm
what is it? SE?
Rifaximin
SE: nausea, elevated ALT
4 other tx for IBS
- probiotics (caution in diverticulitis, ulcer, perforation)
- peppermint oil capsules (Ibguard)
- fecal microbiota transplant (inconclusive)
- lifestyle– less smokng, sugar substitutes, birthcontrol for periods, aerophagia
how does abdominal pain from IBS typically present
cramping, diffuse and relieved by bowel movement
describe IBS diarrhea
watery, NOT bloody
bloody would be in UC
