IBS / IBD Flashcards
What is IBS?
Bowel symptoms for which a cause cannot be found
Epidemiology of IBS
Affects around 10-20% of adults
Pathophysiology of IBS
Altered motor and sensory function of the GIT
Clinical presentation of IBS
Abdominal discomfort Altered bowel habits Relief on defecation Bloating Sensation of incomplete emptying
RFs for IBS
Sexual abuse
Age <50
Female
Pre. enteric infection
Method and criteria required for Dx of IBS
ROME criteria
Aldo discomfort > 12 wks which is removed by defecation + 2 of urgency, incomplete evacuation, bloating etc
Ix in IBS
FBC Stool studies Plain AXR Flexible sigmoidoscopy Colonoscopy
DDx IBS
Chrons/UC
Coeliac
Colon Ca
Management of IBS
Mainly lifestyle modifications
If constipation dominant
- +/- laxatives
- +/- antispasmodics
If diarrhoea dominant
- +/- antidiarrhoeal
- +/-antispasmodics
Exclusion criteria for IBS
>40 years Blood stool Anorexia Wt. loss Diarrhoea at night
Differences in pathology between Crohn’s and UC
Crohn’s:
- mouth to anus
- skip lesions
- strictures present
- Granulomas present
UC:
- Rectum and colon
- Contiguous
- No strictures
- No granulomas
Epidemiology of UC
100-200/100K
Peak 30s
Smoking protective
TH2 mediated
Epidemiology of Crohns
50-100/100K
Peak 20s
Smoking increases risk
Systemic symptoms of both Crohns and UC
fever
malaise
anorexia
wt. loss in active disease
Symptoms specific to Crohns
Diarrhoea
Abdo pain
Wt. loss
PR normal
Symptoms specific to UC
Diarrhoea Blood and mucus PR Abdominal discomfort Tenesmus Urgency
Abdominal signs seen in UC
Fever
Tender distended abdomen
Abdominal signs seen in Crohns
Mouth ulcers Glossitis Abdominal tenderness RIF mass Anal strictures
Extra ambominal signs comment to both UC and Cr
Skin: clubbing, erythema nodusum
Eyes: Iritis / conjunctivitis
Joints: arthritis
RFs for IBD
+FHx
- smoking
- NSAIDs
- Good hygiene risks chances of CD
- HLAB77 +ve (UC)
Some complications of UC
Toxic megacolon
Bleeding
Malignancy
Some complications of Crohns
Fistulae
Strictures
Abscesses
Malabsorption
Investigations to order in Cr
Bloods: FBC, LFT, CRP/ESR, Haematinics, Cultures
Stool studies
Imaging
Endoscopy
Management of Cr
- Vaccinate against influenza, hep B, HPV, VZV, PPV
- Severe: admit + IV steroids + Abx + LMWH
- If no improvement then medical: MTX +/- infliximab or surgery
Management of UC
Severe: Admit + IV hydration + NBM + IV steroids + LMWH
Improvement: Switch to oral pred.
No improvement: rescue therapy: medical - ciclosporin + infliximab or surgical
