IBS + constipation Flashcards by Eilidh Seaton

What causes IBS

Unknown cause related to gut sensitivity and altered motility
No inflammation or damage to bowel

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What brings IBS on

Stress
Anxiety
Depression
Emotional distress 
Menstruation
Gastroenteritis

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What are the S+S of IBS

Rome Criteria 
Abdominal pain +2 of 
Relief by defaecation
Altered frequency
Altered form - Constipation or Diarrhoea 
>6 months

Other 2/4
Urgency / straining 
Incomplete evacuation 
Bloating 
Worse by eating 
Mucous / bleeding in stool

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What is characteristic of IBS abdominal pain

Radiate to back 
Vague 
Burning 
Altered by bowel action
Rare at night  
Non-cyclical (endometriosis can mimiic)

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What are other features

Lethargy
Nausea
Backache
Bladder issues

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What investigations do you perform in IBS

Clinial with Rome criteria if no red flag

Bloods - FBC, ESR, CRP, coeliac if classic Hx to exclude +- calprotectin + stool culture (in GP)
VE and abdo exam
Urea breath test

Colonoscopy if 60+ / alarm symptoms
Refer if FH ovarian / bowel

Consider clinical context but don't do regularly 
Thyroid
Coeliac serology
Ca-125 
Stool culture
Calprotectin 
Rectal examination 
FOB
B12 deficiency
Hydrogen breath

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What is calproctectin

Marker of inflammation in mucosa
Detects neutrophils in the stool
Differentiates IBD and IBS

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How do you treat IBS non-pharmacological

Dietic review - FODMAP, lactose, gluten
Exercise
Reduce stress
Psychotherapy if refractory >12 months

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How do you treat pain in IBS

Anti-sposmodics - Buscopan for colicky pain

Antidepressants - TCA 2nd line or SSRI (also if refractory)

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How do you treat bloating

Probiotics

Avoid fibre and bulking agents

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How do you treat constipation

Laxatives
- 5HT4
Avoid FODMAP
Water + fibre

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How do you treat diarrhoea

Anti-motility agent - loperamide = 1st line
FODMAP
Avoid caffeine / alcohol

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What are alarm symptoms in IBS requiring colonoscopy

50+ as unlikely to have IBS 
Short history <6 months 
Recent change in bowel habit 
Weight loss
Nocturnal symptoms 
Male 
FH Bowel / ovarian ca / IBD 
Mouth ulcers 
Anaemia
Abnormal CRP 
Rectal bleeding
Abdominal mass or LN 
\+e FOB 
Recent antibiotic use as decreased diversity

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What drugs cause constipation

Opiates
Anti-cholinergic 
Iron 
Diuretic
CCB

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What are neurogenic causes of constipation

Neuropathy
Parkinson's
Stroke
MS
Spinal cord injury
Systemic sclerosis

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What are organic causes

Strictures
Malignancy 
Diverticulitis 
IBD
Fissure
Prolapse 
Obstruction 
Psuedo-obstruction after operation
Gastrostasis due to DM 
Hisprung;s

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What are systemic causes of constipation

Diabetes
Low thyroid
Hyper-calcium
Hypokalaeimia

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What are functional causes of constipation

Mega colon
Depression
Psychosis 
Pain 
No toilet

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What are other causes of constipatio

Lack of fibre
Lack of exercise
Unhealthy BMI
Dehydrated
Age 
Hospital / post-op

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How do you Dx constipation

DRE to look for impaction 
Bowel sounds
Abdo exam 
FBC, ESR, U+E, Ca, TFT 
Colonoscopy if suspected malignancy

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How do you treat constipation

Lifestyle advice - drink more, high fibre
Diet advice
Bulking agent e.g. fibrogel
Oral laxative
Suppository - push past stool
Phosphate Enema - useful if impacted before using laxative (water)

What are complications of constipation

Haemorrhoids
Faecal impaction
Overflow incontinence 
Acute urinary retention 
Delerium

What is 1st line laxative

Stimulant e.g. senna to increase motility

What is 2nd line

Add laxido (movicol) - isotonic 
1st line in kids

What is next line

Osmotic = lactulose to retain fluid - may need if long standing and stools very hard - Need to drink lots

What are other options

Pro-kinetic drugs Metaclopramide (D2) - useful in pseudo Azithromycin

When is metaclopramide CI

Obstruction as risk of perforation

What do you do for gastroporesis

``` NBM NG tube TPN if longer Change meds to IV if NG tube Depact colon ```

What does laxative abuse cause

Melanosis coli | Pigetned laden macrophages

What suggests further investigation

Weight loss MASS PR Blood Anaemia

What is constipation

``` <3 stool a week Difficulty passing Pain Bloating Incomplete ```

What shows degree of obstruction

Can they pass wind

What is small bowel overgrowth syndrome

Excessive amounts of bacteria in small bowel

How does it present

``` Chronic diarrhoea Bloating Flatulence Abdoinal pain Similar to IBS ```

Who is at risk

``` Neonates with GI abnormality Scleroderma Systemic sclerosis DM Gastrectomy Hypothyroid ```

What is 1st line test

Hydrogen breath test

How else do you Dx

Small bowel aspiration and culture = diagnostic Stool culture Bile acid breath Endoscopy

How do you treat

Ax? Rifaximin Mettronidazole Co-amox

What does obesity cause

``` Gall bladder disease Pancreatitis NAFLD GORD Cancer Hypertension Heart disease Stroke ```

What is normal BMI

18.5-25

What is overweight

25-30

What is obese

30+

What is underweight

<18.5

What are options

Gastric band Gastric bypass Sleeve gastrectomy

What is gold standard

Combination - roux en y bypass

What does a gastric band do

Decrease size of stomach by a band Minor op Reversible Risk of prolapse

What does a bypass do

Bypass segments of bowel Leads to quick weight loss Dumping syndroe Malabsorption

What does a sleeve gastrectomy do

Removes past of stomach More invasive No dumping syndrome or foreign body

What are the complications of gastric surgery

``` Anastomotic leak DVT / PE Infection Malnutrition Vitamin deficiency Hair loss Dumping ```

What needs excluded if IBS Sx + >50

Ovarian cancer