IBS Diarrhea

Question 1

IBS

Answer 1

MC in females 18-34

MC GI diagnosis

Question 2

IBS: pathophysiology

Answer 2

1. Abnormal GI motility
2. Visceral hypersensitivity
3. Psychopathology

Question 3

Rome IV criteria

Answer 3

• recurrent ABD pain
• at least 1 day a week
• During last 3 months

Question 4

IBS history

Answer 4

some patients repost acute viral or bacterial gastroenteritis prior to onset of IBS

Question 5

IBS: PE

Answer 5

pretty normal, possibly tenderness

Question 6

If patient presents with IBS symptoms, what labs do you order

Answer 6

1. CBC
2. Celiac
3. CRP, if diarrhea

Question 7

Alarm features of IBS

Answer 7

>50 years
Rectal bleeding or melena
Nocturnal diarrhea
Progressive abdominal pain
Unexplained weight loss
Abnormal labs: CBC, CMP, H/H
Recent antibiotics
Recent travel

Question 8

If patient with IBS has rectal bleeding what test is indicated?

Answer 8

flex sigmoid/colonoscopy

Question 9

If patient is 45 and has IBS symptoms what is the best test?

Answer 9

colonoscopy

Question 10

What is the most important Tx for IBS?

Answer 10

Establish positive clinician-patient relationship

2. Lifestyle and diet modification

Question 11

IBS-C: treatment

Answer 11

1st line: psyllium fiber

2nd line: MIralax (osmotic laxatives)

Question 12

IBS-D: treatment

Answer 12

1st line: antidiarrheal agents - Ex. Loperamide before meals

2nd line: cholestyramine (bile acid sequestrant - post cholecystectomy)

Question 13

IBS, severe symptoms, refractory

Answer 13

1. Antidepressants (ex. TCAs for IBS-D)

2. SSRI (ex. Zoloft) in IBS- C since this causes diarrhea

Question 14

What is the difference between constipation and IBS-C

Answer 14

IBS-C has pain

Question 15

Rome IV: constipation

Answer 15

• symptoms for 3 months

- symptoms started in last 6 months

Question 16

Constipation: PE

Answer 16

1. Anal wink
2. DRE
3. Pelvic exam - evaluated for pelvic floor dysfunction

Question 17

Constipation: labs

Answer 17

• CBC
• CMP
• Thyroid

Question 18

What is the initial therapy for constipation?

Answer 18

trial of fiber supplementation

refractory cases: colonic transit study, anorectal manometry

Question 19

Constipation management pearl

Answer 19

Minimize laxative use

Question 20

Who must you be careful about using milk of magnesia in?

Answer 20

renal failure patient

Question 21

Diarrhea duration

Answer 21

Acute: <2 weeks (14 days)

Persistent: 2-4 weeks

Chronic: >1 month

Question 22

Acute diarrhea

Answer 22

MC viral (ex. Rotavirus, adenovirus, Norwalk-like virus)

-bacterial more severe

Question 23

Acute diarrhea: noninflammatory versus inflammatory

Answer 23

non inflammatory: watery (ex. Giardia)

• abdominal cramping
• nausea/vomiting

inflammatory: bloody diarrhea (ex. salmonella, shigella, C diff, campylobacter)
- fever, tenesmus**

Question 24

MCC of bloody diarrhea

Answer 24

enterohemorrhagic E. coli

-NO FEVER**, bloody stool, abd tenderness

Question 25

Microbiologic testing for acute diarrhea will identify which organisms?

Answer 25

Shigella
Salmonella
Campylobacter
Enterotoxigenic E. coli

Question 26

If you suspect EHEC what other tests must be ordered?

Answer 26

1. Culture for E. coli O157:H7

2. Shiga toxin

Question 27

If patient has acute inflammatory diarrhea what tests should you consider?

Answer 27

1. Stool for blood and WBCs (or lactoferrin)
2. Routine stool culture
3. Stool culture for E. coli 157:H7 and stool for Shiga toxin

Question 28

Who should you avoid Loperamide in?

Answer 28

• suspected inflammatory diarrhea
• Fever
• Pediatric patients

Question 29

When should you consider antibiotics for diarrhea?

Answer 29

• immunocompromised
• moderate to severe diarrhea that EHEC and Cdiff are not suspected
• > 6 unformed stools a day
• Symptoms for > 1 week

Question 30

What antibiotic is preferred for diarrhea?

Answer 30

Ciprofloxacin for 3-5 days

DON’T use ABO if bloody diarrhea