IBS + Gastro Hormones

Question 1

Cronhs

CF

Answer 1

• characterized by chronic abdo pain + altered bowel habits
• often have pain related to defecation, some have relief, some pain worsens on defecation
• altered bowel habits - mostly diarrhoea or constipation or alternating

Question 2

IBS Diagnostic criteria

Answer 2

-ROME IV criteria: recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria

• Related to defecation
• Associated with a change in stool frequency
• Associated with a change in stool form (appearance)

Question 3

Red Flags IBS

Answer 3

• Onset after 50
	• Rectal bleeding or malena
	• Nocturnal diarrhoea
	• Progressive abdo pain
	• Unexplained weight loss
	• Laboratory abnormalities
      Family hx of ca

Question 4

Ix IBS

Answer 4

• CRP
• rule out infections and celiac disease
• faecal calprotectin - negative
• cytolethal distending toxin B and anti-vinculin titres - higher in IBD

Question 5

Mx IBS

Answer 5

1. Dietary modification
   a. - reduce “gas-producing” foods
   b. FODMAPs
   c. Lactose or gluten avoidance
   d. High fiber food
2. Physical activity
3. Allergy testing
4. Pharmacology
   a. Laxatives
   b. Anti-diarrheal agents
5. Abdo pain - Buscopan, peppermint oil, mebeverine
6. Cognitive behavioural therapy
7. Antidepressants ?reduces visceral hypersensitivity –>reduces abdo pain
   a. Amitriptyline or nortriptyline
   b. Citalopram
   c. Fluoxetine
   Probiotics

Question 6

GI tract hormones

1. Gastrin
2. Secretin
3. CCK

Answer 6

1. Gastrin - secreted by stomach, stimulates secretion of HCL and pepsinogen. Increases stomach motility. Inhibited by low pH in stomach, stimulated by food
2. Secretin - secreted in duodenum, released bicarb
3. CCK - secreated in duodenum - releases pancreatic enzymes, stimulates GB contraction and slows gastric emptying

Question 7

Hormones - stimulate hunger

Answer 7

1. Gherlin - secreted by stomach, is anti-leptin and stimulates hunger by triggering hypothalamus
2. NPY and AgRP

Question 8

Hormones - stimulate satiety

Answer 8

1. Leptin - secreted by fat (mostly adipose tissue), inhibits NPY and AgRP. Stimulates POMC and CART
   Obesity ?leptin resistance
2. GLP 1 - delays gastric emptying
3. POMC, CART - hypothalamus
4. Insulin