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Gen Med: GI > IBS/constipation/colon polyps > Flashcards

IBS/constipation/colon polyps Flashcards

1
Q

What are the general characteristics of IBS?

A
  1. Functional disorder without known pathology
  2. Most common cause of chronic or recurrent abd pain in US
  3. Intermittent, lifelong problem
  4. F > M
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2
Q

What is the pathophys of IBS?

A
  1. Altered motility
  2. Hypersensitivity to intestinal distention
  3. Psychological distress
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3
Q

What are the sxs of IBS?

A 
1. Abd pain
A. Hypogastrium
B. LLQ
2. Pain worsened w/ food & relieved w/ defecation
3. Postprandial urgency
4. Bowel distention
A. Accumulation of gas
5. Constipation, diarrhea or both
6. PE usually normal
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4
Q

What is the ddx for IBS?

A
  1. Lactose intolerance
  2. Cholecystitis
  3. Chronic pancreatitis
  4. Intestinal obstruction
  5. Pancreatic CA
  6. Stomach cancer
  7. Celiac disease
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5
Q

What dx studies are used for IBS?

A
  1. Dx of exclusion
  2. Stool for O&P, fecal WBC’s, blood, culture
    A. R/O infection
  3. CT w/contrast/Ba enema
    A. R/O obstructing mass, pancreatic cancer
  4. Endoscopy
    A. R/O celiac disease, stomach cancer
  5. Lactase breath test
    A. R/O lactose intolerance
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6
Q

What are the non medical options for treatment of IBS?

A
  1. Reassurance
  2. Strong provider-patient relationship
  3. Avoidance of known triggers
  4. High fiber diet
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7
Q

What bulking agents can be used to treat IBS?

A
  1. Psyllium / Metamucil
  2. Methylcellulose / Citrucel
  3. Calcium Polycarbophil /FiberCon
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8
Q

What antispasmodic meds can be used in IBS?

A
  1. Blocks parasympathetic stimulation of gut and reduces GI tone & motility
    A. Dicyclomine HCl (Bentyl)
    B. Hyoscyamine sulfate (Levsin)
    C. Phenobarb/hyoscyamine/atropine/scopolamine (Donnatal)
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9
Q

What anti-diarrheal meds can be used for IBS?

A
  1. Opioid Agonists
    A. Activate opioid receptors in GI smooth muscle -> inhibits AcH release -> inhibits peristalsis
  2. Includes:
    A. Loperamide (Immodium) – opioid analogue
    B. Diphenoxylate (Lomotil)
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10
Q

What anti-constipation meds can be used for IBS?

A
  1. Increase intestinal fluid secretion & motility
    A. Lubiprostone (Amitiza)
    B. Linaclotide (Linzess)
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11
Q

What prokinetic meds can be used for IBS?

A
  1. Stimulates motility of upper GI tract w/out stimulating gastric, biliary or pancreatic secretions
  2. Metochlopramide (Reglan) 10 mg po 30 min ac & hs
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12
Q

What are the antidepressants/antidiarrheal drugs used for females with IBS?

A
  1. Used in severe cases only, restricted use
  2. Serotonin (5HT3) receptor agonist
  3. Slows down GI motility
  4. Alosetron (Lotronex)
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13
Q

What are the general characteristics of constipation?

A
  1. Normal bowel function ranges from 3 stools/day to 3 stools/week
  2. Decrease in stool volume & increase in stool firmness accompanied by straining
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14
Q

Who should be checked for colon cancer?

A

Patients > 50 yr with new onset constipation should be evaluated for colon cancer

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15
Q

What is the etiology of primary constipation?

A
  1. Anal stricture
  2. Rectocele
  3. Rectal prolapse
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16
Q

What is the etiology of secondary constipation?

A 
1. Systemic disease
A. Hypothyroidism, DM, hypercalcemia
2. Medications
A. Opioids, diuretics, anticholinergics, Ca & Fe supplements
3. Obstructing colonic lesions
17
Q

What dx studies need to be performed for constipation?

A 
1. Complete Hx & PE is essential, including:
A. DRE
B. Stool guaiac
C. CBC
D. Electrolytes
E. Ca, glucose
F. TSH
G. Colonoscopy
18
Q

What is the rx for constipation?

A 
1. Increase fiber 
A. 10-20 gm daily
2. Increase fluid intake
A. 1.5 – 2 L / day
3. Increase activity
4. If constipation lasts > 2 weeks or if constipation refractory to above measures, further investigation to detect etiology
19
Q

What are colon polyps?

A
  1. Colon polyps are discrete mass lesions that protrude into intestinal lumen
    A. Can be benign or malignant
20
Q

What are risk factors for colon cancer?

A
  1. Removal of colon polyps can reduce occurrence of colon cancer
  2. Familial polyposis syndrome is a genetic predisposition to multiple colon polyps
    A. High risk colon cancer
21
Q

What are mucosal neoplastic (adenomatous) polyps?

A
  1. Most common type

2. 95% adenocarcinoma of colon arise from these polyps

22
Q

What are mucosal non-neoplastic (hyperplastic) colon polyps?

A

Non-malignant

23
Q

What are submucosal colon polyps?

A
  1. Lipomas

2. Lymphoid aggregates

24
Q

What preventative measures may reduce the risk of colon polyps?

A
  1. Diet high in fruits, vegetables & fiber
  2. Low fat diet
  3. Limit ETOH intake
  4. Avoid tobacco
  5. Anti-oxidant vitamins
    A. A, C, E, beta carotene
25
Q

When is ASA recommended as a preventative treatment for colon polyps?

A
  1. Due to risks asst w/long term use, ASA not recommended in pts w/polyps unless there are other medical indications
  2. Reduces number of recurrent adenomas at 1-3 yr
    A. Low dose ASA 81 mg PO qd
    B. Celecoxib (Celebrex) 400 mg PO bid
26
Q

What are the risk factors for colon polyps?

A
  1. Diet rich in fats and red meats
  2. (+) FH
  3. IBS
  4. Age
27
Q

What are the sxs of colon polyps?

A
  1. Polyps generally asymptomatic

2. May be asst with rectal bleeding & iron deficiency anemia

28
Q

What are the dx studies for colon polyps?

A
  1. Guaiac (+) stool common
  2. Imaging studies:
    A. Barium enema: Not used much today
    B. Colonoscopy: Diagnostic study of choice for localizing & identifying (Bx) polyps
    -Histologic evaluation of polyps
    C. Virtual colonoscopy/pill camera
29
Q

When should a pt w/ FH of familial polyposis be evaluated?

A

Family members of pts w/ familial polyposis should be evaluated q 1-2 yr beginning at 10-12 yr of age

30
Q

What is the rx for colon polyps?

A

Colonoscopic polypectomy

31
Q

What is recommended post-polypectomy surveillance?

A
  1. Colonoscopy w/in 3-5 yr after initial exam
    A. Adenomas found in 30-40% of pt after initial (+) exam
    B. Colonoscopy in 5-10 yr after first normal post-polypectomy exam
  2. Patients with 3-10 adenomatous polyps or polyp > 1 cm
    A. Colonoscopy in 3 yr
32
Q

What is familial adenomatous polyposis?

A

Inherited condition characterized by early development of hundreds to thousands of colonic adenomatous polyps & adenocarcinoma

33
Q

What genetic testing is available for FAP?

A
  1. Genetic testing confirms mutation of:
    A. APC gene (90%)
    B. MYH gene (8%)
34
Q

What is the recomneded preventative treatment for FAP?

A
  1. Prophylactic colectomy recommended to prevent otherwise inevitable colon cancer
    A. Usually before age 20 yr
35
Q

Who needs colonoscopies every 3 years?

A
  1. baseline colonoscopy with Low risk adenoma, then high risk adenoma on first surveillance
  2. baseline colonoscopy with high risk adenoma, then high risk adenoma on first surveillance
36
Q

Who needs colonoscopies every 5 years?

A
  1. baseline colonoscopy with Low risk adenoma, then low risk adenoma on first surveillance
  2. baseline colonoscopy with high risk adenoma, then low risk adenoma on first surveillance
  3. baseline colonoscopy with high risk adenoma, then no adenoma on first surveillance
37
Q

Who needs colonoscopies every 10 years?

A
  1. baseline colonoscopy with Low risk adenoma, then no adenoma on first surveillance

Gen Med: GI (16 decks)

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