IBS, diverticulitis and exocrine pancreatic insufficiency Flashcards
epidemiology of IBS
- onset 20-30 - 2x more common in women - 10-20% unreported
IBS aetiology
not understood - food intolerances are precursors - no damage present - hypersensitivity and stress
IBS pathophysiology
- functional disorder - no detectable pathology
IBS symptoms
cramps diarrhoea/constipation flatulence bloating urgency to defecate acid reflux nausea lethargy may be worsened by eating
diagnosis of IBS
pain for 6 months relieved by defecation or stool changes PLUS 2 of…- bloating - altered stool passage - mucus - worsened by eating
ROME IV
- Abdominal pain 1/7 in last 3 months * Symptoms began at least 6 months prior * PLUS two of the following Defecation/frequency/form change
4 types of IBS
C- >25% 1/2D- >25% 6/7M- >25% 1/2 AND >25% 6/7U- cannot be categorised
red flags in IBS
weight loss rectal bleeding family history of cancer loose stools >6 weeks in 60 y/o + inflammatory markers abdominal/rectal masses
IBS treatment
symptom management when not controlled by diet - laxatives/loperamide
treatment for cramping in IBS
- antispasmodics - mebeverine 2. anti depressants - amitriptyline, SSRI
treatment for uncontrolled constipation in IBS
linaclotide
linaclotide pharmacology
guanylate cyclase agonist GC-C –> cGMP –> CFTR action –> intestinal chloride+bicarb –> gi transit increased
what is diverticular disease
symptomatic presence of diverticula
what is diverticulosis
uninflamed, asymptomatic presence of diverticula
what is diverticulitis
one or more inflamed/infected diverticula
epidemiology of diverticular disease
risk increases with age, rare <40 80-85% symptomatic 15-20% of patients with diverticulitis develop complications requiring surgery - mortality
aetiology of diverticular disease
genetics - left sided in west, right in Asiandietary - constipationmostly unknown - muscle wall weakening - abnormal motility
how are diverticula formed
Colonic muscular hypertrophy results in narrowing of lumen and formation of small chamber with high pressure and subsequent diverticula
pharmacology of diverticulitis
- faecal matter/undigested food accumulate in diverticula - mucus/bacteria growth distends diverticula - vascular compromise and perforations - intraluminal pressure increases and inflammation
diverticulosis symptoms
asymptomatic
diverticular disease symptoms
- lower left quadrant pain - worsened by eating, relieved by passing wind- flatulence - can overlap with IBS
symptoms of diverticulitis
- lower left abdominal pain with feversudden bowel change blood/mucus palpable mass malaise n&v wbc raised
how is diverticulosis treated
- good diet - hydration - weight loss/smoking cessation- bulk forming laxatives if required
how is diverticular disease treated
- high fibre diet- bulk forming laxatives - anti-spasmodics when colic - avoid NSAIDs- avoid drugs that slow down motility - codeine/loperamide
red flags for diverticulitis
> 65co-morbidities or immunocompromisedcannot take oral abx dehydratedsigns of acute diverticulitis
signs of acute diverticulitis
mass haemorrhage peritonitis stricture (reduce GI motility, constipation, cramping) fistula (faecaluria, pneumaturia, passing faeces through vagina)obstruction sepsis
treatment for diverticulitis - acute and systemically unwell
co-amox AND metronidazole 5 days (cefalexin if penicillin allergy) OR trimethoprim and metronidazole
causes of pancreatic exocrine insufficiency
pancreatic resection pancreatitis diabetes coeliac disease tumours CF
treatment for acute diverticulitis not systemically unwell
avoid nsaids and opioids - analgesia and represent if symptoms worsen
pharmacology of pancreatic exocrine insufficiency
lack of pancreatic enzymes being secreted into duodenum (amylase, lipase and protease)
symptoms of pancreatic exocrine insufficiency
- 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
treatment for pancreatic exocrine insufficiency
pancreatin - creon - dose tailored to meals - higher for main meals lower for snacks - physical symptoms should ease- clinical manifestations should also improve
what is a colostomy
stoma surgically inserted within colon/large intestine, inserted into final section in descending portion of colon
what is a ileostomy
stoma positioned at the end of small intestine - large intestine removed - more fluid contents
what is a urostomy
stoma that removes urine from the body away from the bladder
