Irritable Bowel Syndrome Flashcards
Pertinent Anatomy IBS
(1) Small Intestines
(2) Large Intestines
(3) Anus
(4) Rectum
True/False
IBS is an acute disease that is characterized by abdominal pain or discomfort that occurs in association with altered bowel habits.
FALSE chronic disease (more than 3 months)
How many months of symptoms are required for diagnosis of IBS
3 months
Lifestyle/Mental Health can cause IBS?
Yes
What issue?
(a) Usually begin in the late teens to twenties
(b) Abnormal stool frequency; abnormal stool form: abnormal stool passage and abdominal bloating or a feeling of abdominal distention.
(c) Hallmark symptom: abdominal discomfort that is relieved immediately after
defecation with a otherwise normal physical exam.
(d) Patients may have other somatic or psychological complaints such as dyspepsia, heartburn, chest pain, headaches, fatigue, myalgias, urologic dysfunction, gynecologic symptoms, anxiety and depression.
(e) These symptoms may be continuous or intermittent.
(f) Abdominal pain usually is intermittent, crampy and in the lower abdominal region
IBS
Diagnosis: IBS
Abdominal discomfort or pain that has at least how many what features?
Two of three
1) Relieved with defecation.
2) Onsite associated with a change in frequency of stool
3) Onsite associated with a change in form of stool.
Diagnosis: IBS
Patients are classified into 3 major categories based on what predominant bowel habits:
1) IBS with constipation (IBS-C) or with diarrhea (IBS-D)
2) Infrequent bowel movements (IBS-U)
3) IBS with mixed constipation and diarrhea (IBS-M)
Alarm Symptoms: IBS
(a) Should rule out all other alternative diagnosis if the patient has any of what symptoms are not typically seen in patients with IBS:
1) Acute onset of symptoms, especially in patients aged > 40-50 years.
2) Nocturnal diarrhea
3) Severe constipation
4) Hematochezia/Unexplained IDA
5) Weight loss
6) Fever
7) Family history of cancer, inflammatory bowel disease, or celiac disease
Physical Exam: IBS
True/False
Usually completely normal
True
True/False
Physical Exam: IBS
Should have associated fevers, rashes, blood in stool etc.
True
Physical Exam: IBS
_______ , especially in the lower abdomen, is common but not pronounced (very mild of at all)
Abdominal tenderness
_______ is a diagnosis of exclusion. A provider should carefully rule out all other disorders with either a detailed history, physical exam, labs/imaging or some combination thereof before considering this diagnosis
IBS
Work-up: IBS
Lab
1) For patients who fulfill the diagnostic criteria for IBS and have no other alarm symptoms, routine blood tests are typically _______.
2) Consider complete blood count, chemistry panel, serum albumin, thyroid
function tests, erythrocyte sedimentation rate when __________.
1) typically unnecessary
2) ONLY if an alternative diagnosis is suspected
True/False
Only get labs and/or imaging if the results will change management of your working diagnosis.
True
Imaging/ Radiology
In all patients age ________ or older who have not had a previous evaluation, _______ should be obtained to exclude malignancy.
50 years or
colonoscopy
True/False
Routine sigmoidoscopy or colonoscopy ARE recommended in young
patients with symptoms of IBS without alarming symptoms
FALSE
Are not..
but should be considered in patients who do not improve with conservative management
Initial Care / Prognosis: IBS
(a) Does not start unless patient has had symptoms for at least ______.
(b) At this point, patients are to be treated symptomatically with emphasis on _______.
(c) Start treatment conservatively and work up to more intensive therapies if conservative therapy does not help.
(d) The majority of patients with irritable bowel syndrome learn to cope with their symptoms and lead productive lives.
a) 3 months
b) lifestyle changes
No definitive treatment currently exists for IBS, however diet is closely associated with bettering and worsening of symptoms.
a) Fatty foods and caffeine exacerbate ___________.
b) Food sensitivities often vary from person to person but ________ should be avoided.
c) High-fiber diet and fiber supplements appears to be of ____ value.
d) Patients with IBS may benefit from a diet low in fermentable oligo-, di-,
and monosaccharides and polyols (FODMAPs); and in select cases, lactose
and gluten avoidance.
a) bloating, flatulence, and diarrhea
b) trigger foods
c) little value
Patients with underlying psychological abnormalities may benefit from
evaluation by _______
Mental Health
