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Foundations III GI (Cholley) > IBS, Constipation, Diarrhea > Flashcards

IBS, Constipation, Diarrhea Flashcards

1
Q

What is the Rome IV criteria for IBS?

A

Recurrent abd pain
≥ 1day/wk
During last 3 months
A/w ≥ 2 of the following - defecation, change in stool frequency, change in stool form

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2
Q

What are the 4 subtypes of IBS?

A

IBS w/ constipation
IBS w/ diarrhea
IBS w/ mixed bowel habits
IBS unclassified

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3
Q

What condition can present exactly like IBS? How do you rule this out?

A

Celiac!

IgA TTG or celiac panel

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4
Q

What labs should be used for dx of IBS?

A

It is a dx of exclusion

Get CBC, celiac, CRP

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5
Q

What imaging can be use to look for stool accumulation & severity in IBS w/ constipation?

A

Abd radiograph

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6
Q

What red flags indicate the pt has something other than IBS?

A 
Age > 50
Rectal bleeding or melena 
Progressive abd pain 
Wt loss
Lab abnormalities 
Fam hx of IBD or colon CA
Recent abx or travel
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7
Q

How should you treat IBS in pts w/ mild & intermittent sx?

A

Lifestyle & diet modification

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8
Q

How should you treat severe IBS-C?

A
  1. Osmotic laxatives (PEG/Miralax)
  2. Lubiprostone (women 18+)

Consider SSRIs (zoloft)

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9
Q

How do you treat severe IBS-D?

A

Antidiarrheal (Loperamide 45 mins before a meal)

Bile acid sequestrants (cholestyramine)

Consider TCAs (low dose)

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10
Q

How do you manage abd pain & bloating in IBS?

A

Antispasmodics (dicyclomine, hyoscyamine)

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11
Q

What are ADEs of PEG/miralax?

A

Bloating/abd discomfort

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12
Q

What is an ADE of lubiprostone?

A

Nausea

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13
Q

What should your differential consist of in regards to constipation?

A 
Colon CA 
Hypothyroidism
DM
Parkinsons, SC lesion 
Proctitis 
Obstruction
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14
Q

What is the Rome IV criteria for constipation?

A

2 or more of the following for ≥ 3 months:

  • Straining > 25%
  • Lumpy or hard stools > 25%
  • Sensation of incomplete evacuation > 25%
  • Sensation of anorectal blockage > 25%
  • Manual maneuvers to facilitate defecation > 25%
  • < 3 BMs/wk
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15
Q

What are the 3 main causes of constipation?

A

Slow-transit

Pelvic floor dysfunction

Meds

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16
Q

Constipation: What should your PE consist of?

A

Anal reflex: anal wink

DRE

Evaluate for rectocele

17
Q

What labs should you order for constipation?

A

CBC, CMP, thyroid

18
Q

What procedure should be performed for high risk pts w/ constipation?

A

Colonoscopy or flex sig/BE

19
Q

In refractory pts, what additional tests are available?

A

Colonic transit study

Anorectal manometry

20
Q

What types of laxatives can be used for tx of constipation?

A

Osmotic (Miralax)

Saline (Milk of mag)

Emollient (Colace)

Stimulant (Senokot)

Stimulant + emollient (Peri-colace)

21
Q

What are complications of constipation?

A

Fecal impaction –> large bowel obstruction

22
Q

What are the 3 subtypes of diarrhea?

A

Acute: ≤ 14 days duration
Persistent: 14-30 days
Chronic: > 30 days

23
Q

What causes acute diarrhea?

A

MC = rotavirus, adenovirus, norwalk-like virus

Bacterial: campylobacter, salmonella, shigella

Protozoa: crytosporidium, giardia

24
Q

What is the main differential for acute diarrhea?

A

Fecal impaction

25
Q

What is the presentation of non-inflammatory acute diarrhea?

A

Watery diarrhea w/ abd cramping, N/V, & fever

Viral or Giardia

26
Q

What is the presentation of inflammatory acute diarrhea?

A

Fever & bloody diarrhea, LLQ pain & tenesmus

27
Q

What are characteristics of noninflammatory rotavirus?

A

Causes gastroenteritis in < 2yo, but also affects adults

Sx duration < 1wk

Fever, V/D

28
Q

What is bloody diarrhea MC associated w/ ?

A

Enterohemorrhagic E.coli

29
Q

Noninflammatory diarrhea w/ vomiting suggests what?

A

Viral enteritis or food poisoning

30
Q

Proctitis & rectal discharge suggest…

A

gonorrhea, LGV

31
Q

What is enterohemorrhagic E.coli (EHEC) associated w/?

A

Hemolytic Uremic Syndrome (HUS)

*Don’t give abx!

32
Q

What lab studies should be considered if you suspect inflammatory diarrhea?

A

Stool for occult blood & WBCs

Routine stool culture

Stool culture for E.coli 157:H7 & shiga toxin

33
Q

How do you treat acute diarrhea pharmacologically?

A

Loperamide

Bismuth subsalicylate

34
Q

What abx can be used for acute diarrhea (after c.diff & EHEC are r/o) ?

A

Cipro 3-5days OR

azithromycin

Foundations III GI (Cholley) (10 decks)

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