Irritable Bowel Syndome Flashcards
Most common functional bowel disorder
Irritable bowel syndrome
What is IBS
Functional bowel disorder in which abdominal pain is associated with defecation or change in bowel habits
Risk factors for IBS
Young female from an affluent family, recent antibiotic use, depression, bacterial gastroentritis (Camphylobacter)
Can IBS be diagnosed as hypochondriasis
Yes, hypochondriasis is also known as illness anxiety disorder (IAD) which is people diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having mild or no symptoms
How can IBS be classified
Using ROME III classification based on stool consistency
What is IBS-C classification
IBS with constipation
What is IBS-D classification
IBS with diarrhoea
What is IBS-M classification
IBS with mixed bouts of diarrhoea and constipation
What is IBS-U classification
IBS unsubtyped
Pathophysiology of IBS
Abnormal motility, either delayed in IBS-C or accelerated in IBS-D
Visceral hypersensitivity with abnormal sensitization within dorsal horns of CNS due to dysregulation within brain-gut axis
What chemical plays an important role in IBS
Serotonin (5-HT), this is involved in bidirectional communication along brain-gut axis
Cause of IBS
Local inflammation, abnormal colonic flora and bacterial overgrowth, abnormal gas propulsion, food intolerance, genetics
Symptoms of IBS
Lower abdominal pain/discomfort, altered bowel function - urgency, consistency, frequency, bloating
How does ROME 3 identify IBS
Abdominal pain atleast 3 days per month per last 3 months/12 weeks with >= 2 of the following -
Improvement with defecation
Onset association with change in stool frequency
Onset associated with change in stool form
Treatment of IBS
Education, support, diet (high fibre, 20-30g/day), medial management, physical activity, fluid intake, psychological or behavioral options
Medical mangement of IBS
Antispasmodic drugs - Alverine citrate, mebeverine hydrochloride, peppermint oil
Laxative for IBS-C
Anti-motility drugs - Loperamide hydrochloride
2nd line - Low dose tricyclic antidepressant for abdominal pain or discomfort. 5-HT reuptake inhibitor if this doesn’t work
What can be offered to patients without relief of IBS after 12 months of treatment
Psychological intervention
What laxative should be avoided in IBS treatment
Lactulose as it causes bloating, might worsen abdominal pain
What can be used in IBS-D
Loperamide (anti-diarrhoeal). Decreases frequency of bowel movement, improves stool consistency and doesn’t affect abdominal pain or distention
What kind of psychological treatment is available for IBS patients
Psychotherapy, hypnotherapy and cognitive behaviour therapy (CBT)
Ileostomy vs Colostomy stomal appearance
Ileostomy - Tulip flower appearance, narrow
Colostomy - Wider opening
Indications for elective surgery
Medically unresponsive disease Intolerability Dysplasia/metaplasia Growth retardation in children Attempted resolution of extra-intestinal disease
How can the severity of ulcerative colitis be assessed
Using Truelove and Witt criteria
Classified as mild, moderate or severe
Parameters of Truelove and WItt criteria
Number of bowel movement per 34 hours Blood in stool (haematochezia) Pyrexia Heart rate > 90 Anaemia Erythrocyte sedimentation rate > 30
