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