INP midterm - GI Flashcards
Flashcards for the first half of the INP course. This set will cover the GI
What is irritable bowel syndrome (IBS)?
–> IBS is disorder that affects the large intestine
There are “ABC’s”
(A)bdominal pain or discomfort
(B)loating and flatulence
(C)hange in bowel habit (Stool urgency or straining and incomplete evacuation)
–> They also have increased incidence of extra-intestinal symptoms such as headaches and mild joint pain.
What are the diagnostic criteria for IBS?
- -> Abdominal pain at least 4 days per month associated with one or more of the following
- Defecation
- Change in frequency of stool
- Change in form (appearance) of stool
–> In children with constipation, the pain does not resolve with the resolution of the constipation
–> After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.
How does IBS affect people’s lives?
–> IBS symptoms intermittent, often overlap with other functional and organic disorders, impair quality of life, and result in high healthcare costs
–> IBS is associated with significant decrease in QoL and major economic burden on patients, healthcare systems and the wider community.
–> Treatment often involves a million-dollar workup and a provider who may not be familiar with the disease and how to treat it.
–> Adolescents with frequent abdominal pain are at increased risk of depressive symptoms and social isolation, in addition to missing school (Youssef et al) 30% higher chance of depression
–> Parents have to handle increased costs of healthcare use, lost wages and disruptions to family plans and activities
–> Approximately $30 billion are spent each year for healthcare and lost wage costs related to adults with IBS alone
What evidence suggest that IBD is a polygenic disease?
The current belief is that IBD is a polygenic disease with a pattern of complex genetic traits The genetic influence of Crohn’s disease is greater than that of ulcerative colitis, although in both disorders there is a 15 to 20% likelihood of a patient having an affected relative, usually a first or second degree relative. There is evidence that pediatric onset IBD patients have a greater likelihood of having a family history of IBD. Familial patterns of disease location or phenotype (fistulizing vs. stenotic disease) exist in Crohn’s disease. However, inheritance does not follow simple Mendelian genetics. The research on genetic susceptibility of inflammatory bowel diseases (IBD) has been tremendous and over 13 chromosomal regions have been identified by genome-wide linkage scanning. Many of these genes are involved in mucosal function, particularly mucosal barrier function.
How does IBS affect people’s lives?
–> IBS symptoms intermittent, often overlap with other functional and organic disorders, impair quality of life, and result in high healthcare costs
–> IBS is associated with significant decrease in QoL and major economic burden on patients, healthcare systems and the wider community.
–> Treatment often involves a million-dollar workup and a provider who may not be familiar with the disease and how to treat it.
–> Adolescents with frequent abdominal pain are at increased risk of depressive symptoms and social isolation, in addition to missing school (Youssef et al) 30% higher chance of depression
–> Parents have to handle increased costs of healthcare use, lost wages and disruptions to family plans and activities
–> Approximately $30 billion are spent each year for healthcare and lost wage costs related to adults with IBS alone
Summarize the pathophysiology of IBS.
Infection/consumption of foods increases intestinal permeability by altering tight junction → leading to localized infection & influx of inflammatory cells → subsequent release of inflammatory mediators alters neuromuscular function within luminal GI → cause symptoms of IBS (abdominal pain, bloating, etc).
How do psychosocial events contribute to IBS?
–> Increased life stress, certain personality traits, negative psychological states, negative coping strategies and low social support can all lead to worse IBS
–> Association between pediatric FGIDs and maternal history of –anxiety, depression, somatoform disorders, IBS and migraine
–> According to social learning theory, parental modeling and reinforcement of the sick role increases the likelihood of pediatric functional GI symptoms that may persist into adulthood. Parents need to instill good coping mechanisms.
What is the role of gut microbes in the development of IBS?
–> Microorganisms play a major role in IBS. Based on certain microbiomes patients can present with symptoms similar to IBS
–> IBS patients have a different microbiome than healthy patients.
in non-IBS: Phyla B > Phyla A = Phyla C
in IBS: Phyla A > Phyla B = Phyla C
- Some penetration of antigens because of a bit of leaky gut. This results in antigens getting into the villi of the intestines resulting in inflammation. This inflammation causes neurotransmitters to go in disarray and visceral hypertension/increased pain as well as altered motility.
What are the proposed treatment options for IBS?
–> low FODMAPs, fiber (low), psyllium husk
(F)ermentable (O)logiosaccharides, (D)isachharides, (M)onosaccharides and (P)olyols
–> Probiotics
–> Placebo
–> Antidepressants, antispasmodics, hypnotherapy, yoga, acupuncture, CBT
What are the common extraintestinal manifestations associated with these conditions?
remember JHOES
JOINTS HEPATOBILIARY ORAL EYES SKIN
What is celiac disease?
–> an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals
–> occurs in symptomatic subjects with GI and non-GI symptoms, and in some asymptomatic individuals affected by: Type 1 diabetes, Williams syndrome, Down syndrome, Selective IgA deficiency, Turner syndrome, or have 1st degree relatives with the same disease
What are the symptoms of celiac disease?
*Overall there is an autoimmune issue and blunted villi that impedes nutrient intake and inflammation
in GI: diarrhea, anorexia, abdominal distension and pain, weight loss, vomiting, constipation, irritability
outside of GI: dermatitis, dental enamel hypoplasia, osteopenia/osteoporosis, short stature, delayed puberty, anemia, hepatitis, epilepsy, infertility
What are the complications (both GI and non-GI) from celiac disease?
–> Short stature
–> Dermatitis herpetiformis
–> Dental enamel hypoplasia
–> Recurrent stomatitis
–> Fertility problems
–> Osteoporosis
–> Gluten ataxia and other neurological disturbances
–> Refractory celiac disease and related disorders
–> Intestinal lymphoma
What are the treatments for celiac’s?
only treatment –> GFD gluten free diet
strict diet, and lifelong adherence necessary
avoid: wheat, rye, barley, and oats (initially)
Are there ways to prevent celiac’s?
Prevent via increased duration of breast feeding, BF at gluten introduction b/w 4-7 mo
