Irritable bowel syndrome Flashcards
What is the most common condition to cause changes in bowel habits in the world?
1 - IBS
2 - IBD
3 - coeliacs
4 - colorectal cancer
1 - IBS
- classed as a functional bowel disease
- cause has been linked with gut-brain dysfunction
What is the incidence of the functional bowel disease called irritable bowel syndrome?
1 - 0.2 - 0.3%
2 - 2-3%
3 - 10-20%
4 - 40-60%
3 - 10-20%
Is irritable bowel syndrome more common in men or women?
- women
What ages is irritable bowel syndrome more common in?
1 - 10-20 y/o
2 - 20-30 y/o
3 - 40-50 y/o
4 - >70 y/o
2 - 20-30 y/o
According to the NICE definition, in order to be diagnosed with IBS a patient must have recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months. The patient must also have >2 of the following that have lasted >6 months. Which one of these is NOT one of the true definitions that confirm a diagnosis of IBS?
1 - improvement of symptoms following defaecation
2 - onset associated with change in stool form
3 - onset associated with chronic diarrhoea
4 - onset associated with change in frequency of stool
3 - onset associated with chronic diarrhoea
In IBS patients abdominal pain must also be associated with
- relief following defaecation
- change in bowel habits
- change in stool form
Do patients typically experience IBS symptoms during the evening?
- no
The most common condition to cause changes in bowel habits in the world is IBS. According to the NICE definition, to be diagnosed patients have to have abdominal pain for >6 months with:
- relief following defaecation
- change in bowel habits
- change in stool form
In addition, they must have how many of the following:
- altered stool passage (straining, urgency etc.)
- abdominal bloating
- worse after meals
- passage of mucous PR
1 - >1
2 - >2
3 - >3
4 - all of them
2 - >2
The most common condition to cause changes in bowel habits in the world is IBS. According to the NICE definition, to be diagnosed patients have to have abdominal pain for >6 months with:
- relief following defaecation
- change in bowel habits
- change in stool form
In addition, they must have >2 of the following:
- altered stool passage (straining, urgency etc.)
- abdominal bloating
- worse after meals
- passage of mucous PR
They must also have other diagnoses excluded. Which of the following is NOT one of the conditions that needs to be excluded?
1 - colorectal cancer
2 - diverticulosis
3 - IBD
4 - coeliacs
2 - diverticulosis
In patients with a change in bowel habits, we can use a marker in patients stool to rule out bowel cancer. What is this marker called?
1 - qFIT
2 - faecal calprotecin
3 - CA19
4 - CRP
1 - qFIT
- negative (<10) gives a 99.6% specificity (correctly they do not have cancer)
- positive requires further investigations
If a patient has a positive qFIT, which of the 2 would a clinician most likely perform?
1 - ultrasound
2 - nuclear medicine
3 - colonoscopy
4 - CT colonoscopy
3 - colonoscopy
- gold standard, but poorly tolerated in IBS patients
4 - CT colonoscopy
- high radiation, best to avoid in <40-45 y/o
In IBS, would a colonoscopy be normal or abnormal?
- typically normal
Faecal calprotectin can be used as a measure of inflammation in stool. What is a raised level for faecal calprotectin?
1 - >10ug/g
2 - >50ug/g
3 - >100ug/g
4 - >150ug/g
4 - >150ug/g
In IBS, would a stool microscopy, culture and sensitivities test (MC+S) be normal or abnormal?
- normal
Would we expect a FBC, CRP and coeliac screen to be normal or abnormal in a patient wit IBS?
- typically should all be normal
In IBS we can do a selenium homocholic acid taurine (SeHCAT) test, which is a nuclear test for bile salt absorption. Would we expect to see this normal or abnormal in IBS?
- normal
In IBS would we expect any of the following to be abnormal?
1 - lactulose hydrogen breathe test (SI bacterial overgrowth)
2 - lactose hydrogen breathe test (lactose malabsorption)
3 - fructose hydrogen breathe test
- no
- should all be normal in IBS
In IBS would we expect colonic transit time studies to be normal or abnormal?
- normal
- rules out obstruction, neurological disorder affecting peristalsis as reasons for constipation
In addition to qFIT and colonoscopy, which of the following is NOT a standard investigation a clinician may perform in IBS?
1 - sigmoidoscopy
2 - FBC (anaemia)
3 - coeliac serology
4 - faecal calprotectin
1 - sigmoidoscopy
- vitamin B12 deficiency anaemia can cause other symptoms, such as diarrhoea and/or constipation.
What does red stool suggest?
1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat
1 - fresh blood
- bright red suggests colon or rectum is the source
What does black stool suggest?
1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat
2 - old blood
- melena from upper GI
- peptic ulcer etc..
What does pale stool suggest?
1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat
3 - reduced stercobilin
- biliary obstruction and low stercobilin
What does yellow stool suggest?
1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat
5 - excessive fat
- pancreatic dysfunction
- malabsorption
What does green stool suggest?
1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat
4 - excessive bile
- seen in diarrhoea
In a patient diagnosed with IBS, which of the following is NOT part of the 1st line treatment?
1 - education and reassure patient
2 - lifestyle modification
3 - dietary advise (FODMAP)
4 - senna
4 - senna
In a patient diagnosed with IBS with constipation, which 2 of the following is 1st line treatment?
1 - loperamide
2 - lactulose
3 - buscopan/peppermint oil
4 - rifaximin
2 - lactulose
- osmotic laxative
3 - buscopan/peppermint oil
In a patient diagnosed with IBS with constipation, which 2 of the following is 2nd line treatment?
1 - prucalopride
2 - lactulose
3 - buscopan/peppermint oil
4 - linacliotide
1 - prucalopride
4 - linacliotide
- both are secretalogues that increase secretions into bowel and reduce constipation
In a patient diagnosed with IBS with diarrhoea, which 2 of the following is 1st line treatment?
1 - loperamide
2 - lactulose
3 - buscopan/peppermint oil
4 - rifaximin
1 - loperamide
3 - buscopan/peppermint oil
In a patient diagnosed with IBS with diarrhoea, which 2 of the following is 2nd line treatment?
1 - loperamide
2 - amitriptyline
3 - buscopan/peppermint oil
4 - rifaximin
2 - amitriptyline
- tricyclic antidepressant, that have anti-muscarinic effects that essentially reduces peristalsis
4 - rifaximin
- antibiotic typically prescribed for travellers diarrhoea
Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. What is the incidence of this in adults
1 - 0.1-1%
2 - 1-10%
3 - 20-35%
4 - >50%
2 - 1-10%
- may be under reported
- 0.5-1 experience persistent incontinence affecting QoL
Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. This can be passive or urge incontinence. What is passive incontinence?
1 - unaware involuntary control of bowels
2 - unable to go despite wanting to
3 - aware of episode but still unable to control bowels
4 - unaware and unable to move bowels
1 - unaware involuntary control of bowels
- even with functioning sphincters, diarrhoea can lead to insufficient time to reach toilets
Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. This can be passive or urge incontinence. What is urge incontinence?
1 - unaware involuntary control of bowels
2 - unable to go despite wanting to
3 - aware of episode but still unable to control bowels
4 - unaware and unable to move bowels
3 - aware of episode but still unable to control bowels
- even with functioning sphincters, diarrhoea can lead to insufficient time to reach toilets
Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. This can be passive or urge incontinence. Below are common risk factors for incontinence, except one. Which is this?
1 - younger age
2 - frailty
3 - women (following birth)
4 - neurological or spinal disease
5 - cognitive impairment
6 - rectal prolapse
7 - prior pelvic surgery
8 - prior pelvic radiation
1 - younger age
- more common in older ages
When assessing a patient with faecal incontinence, once we have performed a full history, what is generally the first examination we should perform? (all of these could be done, but which should be first)
1 - defaecating proctogram
2 - endoscopy
3 - axial imaging (transverse)
4 - assess pelvic floor muscles
4 - assess pelvic floor muscles
