IBS + constipation Flashcards
What causes IBS
Unknown cause related to gut sensitivity and altered motility
No inflammation or damage to bowel
What brings IBS on
Stress Anxiety Depression Emotional distress Menstruation Gastroenteritis
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
What is characteristic of IBS abdominal pain
Radiate to back Vague Burning Altered by bowel action Rare at night Non-cyclical (endometriosis can mimiic)
What are other features
Lethargy
Nausea
Backache
Bladder issues
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
What is calproctectin
Marker of inflammation in mucosa
Detects neutrophils in the stool
Differentiates IBD and IBS
How do you treat IBS non-pharmacological
Dietic review - FODMAP, lactose, gluten
Exercise
Reduce stress
Psychotherapy if refractory >12 months
How do you treat pain in IBS
Anti-sposmodics - Buscopan for colicky pain
Antidepressants - TCA 2nd line or SSRI (also if refractory)
How do you treat bloating
Probiotics
Avoid fibre and bulking agents
How do you treat constipation
Laxatives
- 5HT4
Avoid FODMAP
Water + fibre
How do you treat diarrhoea
Anti-motility agent - loperamide = 1st line
FODMAP
Avoid caffeine / alcohol
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
What drugs cause constipation
Opiates Anti-cholinergic Iron Diuretic CCB
What are neurogenic causes of constipation
Neuropathy Parkinson's Stroke MS Spinal cord injury Systemic sclerosis
What are organic causes
Strictures Malignancy Diverticulitis IBD Fissure Prolapse Obstruction Psuedo-obstruction after operation Gastrostasis due to DM Hisprung;s
What are systemic causes of constipation
Diabetes
Low thyroid
Hyper-calcium
Hypokalaeimia
What are functional causes of constipation
Mega colon Depression Psychosis Pain No toilet
What are other causes of constipatio
Lack of fibre Lack of exercise Unhealthy BMI Dehydrated Age Hospital / post-op
How do you Dx constipation
DRE to look for impaction Bowel sounds Abdo exam FBC, ESR, U+E, Ca, TFT Colonoscopy if suspected malignancy
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
