IBS, diverticulitis and exocrine pancreatic insufficiency

Question 1

epidemiology of IBS

Answer 1

• onset 20-30 - 2x more common in women - 10-20% unreported

Question 2

IBS aetiology

Answer 2

not understood - food intolerances are precursors - no damage present - hypersensitivity and stress

Question 3

IBS pathophysiology

Answer 3

• functional disorder - no detectable pathology

Question 4

IBS symptoms

Answer 4

cramps diarrhoea/constipation flatulence bloating urgency to defecate acid reflux nausea lethargy may be worsened by eating

Question 5

diagnosis of IBS

Answer 5

pain for 6 months relieved by defecation or stool changes PLUS 2 of…- bloating - altered stool passage - mucus - worsened by eating

Question 6

ROME IV

Answer 6

• Abdominal pain 1/7 in last 3 months * Symptoms began at least 6 months prior * PLUS two of the following Defecation/frequency/form change

Question 7

4 types of IBS

Answer 7

C- >25% 1/2D- >25% 6/7M- >25% 1/2 AND >25% 6/7U- cannot be categorised

Question 8

red flags in IBS

Answer 8

weight loss rectal bleeding family history of cancer loose stools >6 weeks in 60 y/o + inflammatory markers abdominal/rectal masses

Question 9

IBS treatment

Answer 9

symptom management when not controlled by diet - laxatives/loperamide

Question 10

treatment for cramping in IBS

Answer 10

1. antispasmodics - mebeverine 2. anti depressants - amitriptyline, SSRI

Question 11

treatment for uncontrolled constipation in IBS

Answer 11

linaclotide

Question 12

linaclotide pharmacology

Answer 12

guanylate cyclase agonist GC-C –> cGMP –> CFTR action –> intestinal chloride+bicarb –> gi transit increased

Question 13

what is diverticular disease

Answer 13

symptomatic presence of diverticula

Question 14

what is diverticulosis

Answer 14

uninflamed, asymptomatic presence of diverticula

Question 15

what is diverticulitis

Answer 15

one or more inflamed/infected diverticula

Question 16

epidemiology of diverticular disease

Answer 16

risk increases with age, rare <40 80-85% symptomatic 15-20% of patients with diverticulitis develop complications requiring surgery - mortality

Question 17

aetiology of diverticular disease

Answer 17

genetics - left sided in west, right in Asiandietary - constipationmostly unknown - muscle wall weakening - abnormal motility

Question 18

how are diverticula formed

Answer 18

Colonic muscular hypertrophy results in narrowing of lumen and formation of small chamber with high pressure and subsequent diverticula

Question 19

pharmacology of diverticulitis

Answer 19

• faecal matter/undigested food accumulate in diverticula - mucus/bacteria growth distends diverticula - vascular compromise and perforations - intraluminal pressure increases and inflammation

Question 20

diverticulosis symptoms

Answer 20

asymptomatic

Question 21

diverticular disease symptoms

Answer 21

• lower left quadrant pain - worsened by eating, relieved by passing wind- flatulence - can overlap with IBS

Question 22

symptoms of diverticulitis

Answer 22

• lower left abdominal pain with feversudden bowel change blood/mucus palpable mass malaise n&v wbc raised

Question 23

how is diverticulosis treated

Answer 23

• good diet - hydration - weight loss/smoking cessation- bulk forming laxatives if required

Question 24

how is diverticular disease treated

Answer 24

• high fibre diet- bulk forming laxatives - anti-spasmodics when colic - avoid NSAIDs- avoid drugs that slow down motility - codeine/loperamide

Question 25

red flags for diverticulitis

Answer 25

> 65co-morbidities or immunocompromisedcannot take oral abx dehydratedsigns of acute diverticulitis

Question 26

signs of acute diverticulitis

Answer 26

mass haemorrhage peritonitis stricture (reduce GI motility, constipation, cramping) fistula (faecaluria, pneumaturia, passing faeces through vagina)obstruction sepsis

Question 27

treatment for diverticulitis - acute and systemically unwell

Answer 27

co-amox AND metronidazole 5 days (cefalexin if penicillin allergy) OR trimethoprim and metronidazole

Question 28

causes of pancreatic exocrine insufficiency

Answer 28

pancreatic resection pancreatitis diabetes coeliac disease tumours CF

Question 29

treatment for acute diverticulitis not systemically unwell

Answer 29

avoid nsaids and opioids - analgesia and represent if symptoms worsen

Question 30

pharmacology of pancreatic exocrine insufficiency

Answer 30

lack of pancreatic enzymes being secreted into duodenum (amylase, lipase and protease)

Question 31

symptoms of pancreatic exocrine insufficiency

Answer 31

• maldigestion leading to malnutrition- fatigue- low blood levels of fat soluble vitamins (A, D, E, K)- lack of growth/weight loss - diarrhoea - cramping/bloating- flatulence

Question 32

treatment for pancreatic exocrine insufficiency

Answer 32

pancreatin - creon - dose tailored to meals - higher for main meals lower for snacks - physical symptoms should ease- clinical manifestations should also improve

Question 33

what is a colostomy

Answer 33

stoma surgically inserted within colon/large intestine, inserted into final section in descending portion of colon

Question 34

what is a ileostomy

Answer 34

stoma positioned at the end of small intestine - large intestine removed - more fluid contents

Question 35

what is a urostomy

Answer 35

stoma that removes urine from the body away from the bladder