Irritable Bowel Syndrome

Question 1

Pertinent Anatomy IBS

Answer 1

(1) Small Intestines
(2) Large Intestines
(3) Anus
(4) Rectum

Question 2

True/False
IBS is an acute disease that is characterized by abdominal pain or discomfort that occurs in association with altered bowel habits.

Answer 2

FALSE
chronic disease (more than 3 months)

Question 3

How many months of symptoms are required for diagnosis of IBS

Answer 3

3 months

Question 4

Lifestyle/Mental Health can cause IBS?

Answer 4

Yes

Question 5

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

Answer 5

IBS

Question 6

Diagnosis: IBS

Abdominal discomfort or pain that has at least how many what features?

Answer 6

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.

Question 7

Diagnosis: IBS

Patients are classified into 3 major categories based on what predominant bowel habits:

Answer 7

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)

Question 8

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:

Answer 8

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

Question 9

Physical Exam: IBS
True/False
Usually completely normal

Answer 9

True

Question 10

True/False
Physical Exam: IBS
Should have associated fevers, rashes, blood in stool etc.

Answer 10

True

Question 11

Physical Exam: IBS

_______ , especially in the lower abdomen, is common but not pronounced (very mild of at all)

Answer 11

Abdominal tenderness

Question 12

_______ 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

Answer 12

IBS

Question 13

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 __________.

Answer 13

1) typically unnecessary

2) ONLY if an alternative diagnosis is suspected

Question 14

True/False

Only get labs and/or imaging if the results will change management of your working diagnosis.

Answer 14

True

Question 15

Imaging/ Radiology
In all patients age ________ or older who have not had a previous evaluation, _______ should be obtained to exclude malignancy.

Answer 15

50 years or

colonoscopy

Question 16

True/False
Routine sigmoidoscopy or colonoscopy ARE recommended in young
patients with symptoms of IBS without alarming symptoms

Answer 16

FALSE
Are not..
but should be considered in patients who do not improve with conservative management

Question 17

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.

Answer 17

a) 3 months

b) lifestyle changes

Question 18

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.

Answer 18

a) bloating, flatulence, and diarrhea
b) trigger foods
c) little value

Question 19

Patients with underlying psychological abnormalities may benefit from
evaluation by _______

Answer 19

Mental Health