IBS + constipation Flashcards
What causes IBS [3]
Unknown cause related to gut sensitivity and altered motility
No inflammation or damage to bowel
Functional (thought to be due to disorders of intestinal motility or enhanced visceral perception)
What brings IBS on [6]
Stress Anxiety Depression Emotional distress Menstruation Gastroenteritis
What sxs are part of diagnostic criteria for IBS
Abdominal pain +2 of Relief by defecation Altered frequency Altered form - C or D >6 months
and >2 of: Urgency / straining Incomplete evacuation Bloating Worse after eating Mucous / bleeding in stool
What is characteristic of IBS abdominal pain [5]
Radiate to back Vague Burning Rare at night Non-cyclical (endometriosis can mimic)
What are other features [4]
Lethargy
Nausea
Backache
Bladder issues
What investigations do you perform in IBS [3]
Bloods: FBC, ESR, CRP, LFT, coeliac serology, CA-125 if female
Stool: culture if diarrhoea prominent, faecal calprotectin
Colonoscopy if 60+ / alarm symptoms
Refer if FH ovarian / bowel
What is calproctectin
Marker of inflammation in mucosa - Differentiates IBD and IBS
How do you treat IBS non-pharmacological [4]
Dietic review - FODMAP, lactose, gluten
Exercise
Reduce stress
Psychotherapy if refractory >12 months
How do you treat pain in IBS [2]
Anti-spasmodics
Antidepressants - TCA 2nd line or SSRI (also if refractory)
How do you treat bloating [2]
Probiotics
Avoid fibre and bulking agents
How do you treat constipation [4]
Laxatives
Avoid FODMAP
5HT4
Water + fibre
How do you treat diarrhoea [4]
Anti-motility agent
FODMAP
Loperamide = 1stline
Avoid caffeine / alcohol
What are alarm symptoms in IBS requiring colonoscopy [9]
50+, Male Short history <6 months Waking at night with pain/diarrhea Weight loss FH Bowel / ovarian ca Abnormal CRP, ESR, Low Hb Rectal bleeding Mouth ulcers Abdominal mass Recent antibiotic use as decreased diversity
What drugs cause constipation [5]
Opiates Anti-cholinergic Iron Diuretic CCB
What are neurogenic causes of constipation [6]
Neuropathy Parkinson's Stroke MS Spinal cord injury Systemic sclerosis
What are organic causes [8]
Strictures Malignancy Diverticulitis IBD Fissure Prolapse Obstruction, Psuedo-obstruction after operation Gastrostasis due to DM Congenital: Hirschsprung
What are systemic causes of constipation [4]
Diabetes
Low thyroid
Hyper-calcium
Hypokalaemia
What are functional causes of constipation [5]
Mega-colon Depression Psychosis Pain No toilet
What are other causes of constipation [6]
Lack of fibre Lack of exercise Unhealthy BMI Dehydrated Age Hospital / post-op
How do you Dx constipation [4]
DRE (impaction, rectal tumor)
Abdo exam (mass, tenderness)
FBC, ESR, U+E, Ca, TFT
Colonoscopy if suspected malignancy
How do you treat constipation [6]
Lifestyle advice - drink more, high fibre
Diet advice
Bulking agent e.g. fibrogel
Oral laxative
Suppository
Phosphate Enema - useful if impacted before use laxative
What are complications of constipation [5]
Haemorrhoids Faecal impaction Bowel incontinence / overflow Acute urinary retention Delirium
What is 1st line laxative
Stimulant e.g. senna to increase motility
What is 2nd line
Senna + laxido
What is next line
Isotonic = movical Osmotic = lactulose to retain fluid
What are other options [3]
Pro-kinetic drugs
Metaclopramide (D2) - useful in pseudo
Azithromycin
When is metaclopramide CI
Obstruction as risk of perforation
What do you do for gastroporesis [5]
NBM NG tube TPN if longer Change meds to IV if NG tube Depact colon
What does laxative abuse cause
Melanosis coli
Pigment laden macrophages
What suggests further investigation [4]
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 [5]
Small bowel overgrowth
Chronic diarrhoea Bloating Flatulence Abdominal pain Similar to IBS
Who is at risk [3]
Neonates with GI abnormality
Scleroderma
DM
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
Metronidazole
Co-amox
What is normal BMI
18.5-25
What is overweight
25-30
What is obese
30+
What is underweight
<18.5
What are options [3]
Gastric band
Gastric bypass
Sleeve gastrectomy
What is gold standard
Combination - roux en y bypass
What does a gastric band do [4]
Decrease size of stomach by a band
Minor op
Reversible
Risk of prolapse
What does a bypass do? [2]
Side effects [2]
Bypass segments of bowel
Leads to quick weight loss
SE: Dumping syndrome
Malabsorption
What does a sleeve gastrectomy do [3]
Removes part of stomach
More invasive
No dumping syndrome or foreign body
What are the complications of gastric surgery [5]
Anastomotic leak DVT / PE, Infection Malnutrition Vitamin deficiency Hair loss
