Irritable Bowel Syndrome Flashcards
What is irritable bowel syndrome (IBS)?
It is defined as a functional bowel disorder, in which there is no identifiable disease pathology underlying clinical features
What are the six risk factors of irritable bowel syndrome?
Female Gender
Young Age
Family History
Anxiety
Depression
Stress
What are the nine clinical features of irritable bowel syndrome?
Fatigue
Nausea
Abdominal Pain
Abdominal Bloating
Change In Bowel Habit
Faecal Urgency
Tenesmus
Faecal Mucus
Bladder Features
What are the two characteristics of irritable bowel syndrome clinical features?
The clinical features improve upon defecation
The clinical features worsen upon eating
What two investigations are used to diagnose irritable bowel syndrome?
Blood Tests
Stool Culture
What four blood test results indicative of irritable bowel syndrome?
Normal FBC
Normal ESR Levels
Normal CRP Levels
Negative Coeliac Disease Serology
What is the first line investigation of irritable bowel syndrome?
Anti-TGG levels
What two stool tests are used to diagnose irritable bowel syndrome?
Faecal Calprotectin
Stool Culture
What is faecal calprotectin?
It is an inflammatory marker, which is released during colitis
How is faecal calprotectin used to diagnose irritable bowel syndrome?
It is used to exclude inflammatory bowel disease, which would demonstrate elevated levels of this inflammatory marker
How is a stool culture used to diagnose irritable bowel syndrome?
It is used to exclude gastrointestinal infections
What is the diagnostic criteria required for irritable bowel syndrome?
A diagnosis is obtained in cases where individuals present with a six month history of abdominal pain, which is relieved by defecation or associated with a change in bowel habit.
In addition, individuals should be meet two of the following criteria…
- Abnormal Stool Passage
- Abdominal Bloating
- Clinical Features Worsening Upon Eating
- Mucus Within Stools
What are the five conservative management options for irritable bowel syndrome?
Disease Education & Reassurance
Cognitive Behavioural Therapy (CBT)
Dietary Advice
Increased Fluid intake
Alcohol Cessation
When is CBT recommended to manage irritable bowel syndrome?
In cases where clinical features dont respond to pharmacological treatments after 12 months and who develop a continuing clinical profile
What six dietary recommendations are used to manage irritable bowel syndrome?
Regular meals
Restrict tea and coffee to three cups per day
Reduce alcohol and fizzy drink intake
Limit intake of high-fibre food
Reduce intake of resistant starch, often found in processed foods
Limit fresh fruit to three portions per day
What are the five pharmacological management options for irritable bowel syndrome?
Antidiarrheal Medications
Laxatives
Antispasmodics
Tricyclic Antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
When are antidiarrheals used to manage irritable bowel syndrome?
They are the first line pharmacological management option
How are antidiarrheals used to manage irritable bowel syndrome?
It is used to symptomatically manage diarrhoea
Name an antidiarrheal medication used to manage irritable bowel syndrome
Loperamide
When are laxatives used to manage irritable bowel syndrome?
They are the first line pharmacological management option
How are laxatives used to manage irritable bowel syndrome?
It is used to symptomatically manage constipation
Name four laxatives used to manage irritable bowel syndrome
Isphagula Husk
Bisacodyl
Senna
Sodium Picosulfate
What is the first line bulk-forming laxative used to manage irritable bowel syndrome?
Isphaghula Husk
What laxative is used when individuals with constipation are not responding to conventional laxatives? What are the two criteria required?
Linaclotide
The optimal tolerated doses of previous laxatives from different classes have not improved clinical features
They have had constipation for at least 12 months
When are antispasmodics used to manage irritable bowel syndrome?
They are the first line pharmacological management option
How are antispasmodics used to manage irritable bowel syndrome?
It is used to symptomatically manage abdominal pain
Name an antispasmodics used to manage irritable bowel syndrome
Hyoscine butylbromide
When are tricyclic antidepressants used to manage irritable bowel syndrome?
They are the second line pharmacological management option
How are tricyclic antidepressants used to manage irritable bowel syndrome?
They are used to manage risk factors, such as anxiety and depression
Name a tricyclic antidepressant used to manage irritable bowel syndrome. What dose is recommended?
Amitriptyline
Low dose 5mg - 10mg
When are SSRIs used to manage irritable bowel syndrome?
They are the third line pharmacological management option
How are SSRIs used to manage irritable bowel syndrome?
They are used to manage risk factors, such as anxiety and depression
Name two SSRIs used to manage irritable bowel syndrome
Fluoxetine
Sertraline
