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Pharmacology > Irritable Bowel Syndrome > Flashcards

Irritable Bowel Syndrome Flashcards

1
Q

What is IBS?

A

A life long relapsing condition of the lower GI tract that is often life irregular

It is caused by spasm like pain that causes irregular bowel habits.

Suspected if symptoms for at least 6 months:
1. Abdominal pain
2. Bloating
3. Change in bowel habit

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2
Q

Which gender is more affected by IBS?

A

Females 2:1

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3
Q

What is the pathogenesis of IBS?

A

IBS is a functional disorder with no known structural, anatomic or biochemical lesions

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4
Q

What causes abnormal GI motility?

A
  1. Visceral hypersensitivity
  2. Abnormal immune function
  3. Change in colonic microbiota
  4. Abnormal central pain processing of afferent gut signals
  5. Abnormal autonomic activity
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5
Q

How would you diagnose a patient with IBS?

A

If the patient reports abdominal pain or discomfort that is either relieved by defecation or associated with altered bowel frequency or altered stool form.

Also:
1. Altered stool passage
2. Passage of mucus
3. Abdominal bloating, hardness, distension or tension
4. Symptoms made worse by eating

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6
Q

What is type 1 stool?

A

Separate hard lumps

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7
Q

What is type 2 stool?

A

Sausage shaped but lumpy

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8
Q

What is type 3 stool?

A

Like a sausage but with cracks on its surface

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9
Q

What is type 4 stool?

A

Like a sausage or snake, smooth and soft

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10
Q

What is type 5 stool?

A

Soft blobs with clear cut edges

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11
Q

What is type 6 stool?

A

Fluffy pieces with ragged edges - a mushy stool

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12
Q

What is type 7 stool?

A

Watery - no solid pieces
Entirely liquid

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13
Q

What questions would you ask in a clinical assessment?

A
  1. Type and severity of symptoms
  2. Impact of symptoms on daily functioning
  3. Diet, nutrition and known food triggers
  4. Exercise and physical activity levels
  5. Any recent stresses, anxiety, depression
  6. Rectal bleeding
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14
Q

What would you examine in a patient for IBS?

A
  1. Check weight - calculate BMI, assess for unintended or unexplained weight loss
  2. Palpate the abdomen for signs of tenderness or masses
  3. Rectal examination to exclude perinatal or rectal pathology
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15
Q

What diagnostic tests would you do for IBS?

A

IBS is a diagnosis of exclusion - there is no specific diagnosis

If IBS criteria met check: to exclude other diagnosis
1. FBC
2. ESR
3. CRP
4. Antibody testing for coeliac disease

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16
Q

What are the non GI symptoms?

A
  1. Lethargy
  2. Nausea
  3. Backache
  4. Headache
  5. Bladder symptoms
17
Q

What are the lower GI alarm symptoms?

A
  1. > 40 with unexplained weight loss and abdominal pain
  2. > 50 unexplained rectal bleeding
  3. > 60 with occult blood in the faeces, IDA and changes in bowel habit
  4. <50 with rectal bleeding, unexplained weight loss, IDA, abdominal pain and change in bowel habit
18
Q

What are the differential diagnoses that could be made?

A
  1. Ulcerative colitis
  2. Crohns
  3. Gallstones
  4. Peptic ulcer
  5. Coeliac
  6. Chronic pancreatitis
  7. Hypo/hyperthyroidism
  8. GORD
  9. Laxative misuse
  10. Antibiotic associated diarrhoea
  11. Malignancy
19
Q

What general dietary advice could you give to a patient?

A
  1. Take regular meals
  2. Avoid missing meals/long gaps
  3. Drink >8 cups of fluid per day
  4. Restrict tea/coffee to 3 cups per day
  5. Limit fresh fruit to 3 portions per day
  6. Reduce alcohol and fizzy drinks
  7. Reduce intake of resistant starch - rice, beans and potatoes
  8. Avoid sorbitol if diarrhoea
  9. Eating oats may help wind and bloating
20
Q

What advice would you give regarding fibre?

A

Diarrhoea - reduce insoluble fibre (whole grain, wheat and veg)

Constipation - increase in soluble fibre

If advised to increase dietary fibre this should be soluble fibre such as ispaghula husk or foods high in soluble fibre such as oats and nuts

21
Q

What foods are high in FODMAPs?

A
  1. Many green veg
  2. Most lactose containing foods
  3. Some fruits (cherries, apples, peaches and nectarines)
  4. Artificial sweeteners
22
Q

When are antispasmodics used?

A

When abdominal pain is the predominate side effect

23
Q

How do antispasmodics work?

A

Relax the smooth muscle of the gut and relieve the spasm and distension

24
Q

What are the antispasmodics and their side affects?

A

Mebeverine - generally well tolerated and can be used on an as req basis

Hyoscine butylbromide - alleviates colicky pain of GI spasm
Can cause dry mouth, blurred vision or palpitations
C/I in patients with glaucoma
Used with caution in pregnant women, elderly and prostate problems

25
Q

What is the second line treatment of IBS?

A

Antidepressants - SSRI’s or TCA’s

26
Q

How do antidepressants relieve IBS?

A

Potentiate analgesics and may alter pain perception
Normalise GI transit time

27
Q

TCA’S…..

A

Start at low dose (5-10mg equivalent of amitriptyline ON - off label indication)
Dose should rarely exceed 30mg
S/E’s include drowsiness, fatigue, dry mouth and constipation
Try for at least 4 weeks and review every 6-12 months

28
Q

SSRI’s…..

A

Low dose if TCA’s not tolerated,C/I or ineffective
Eg. Citalopram 20mg OD

29
Q

What would you prescribe in IBS-D?

A

Loperamide and co-phenotrope

30
Q

Loperamide…..

A

Preferred as it doesn’t cause confusion or anti-cholinergic S/E’s
Available as a syrup for fine tuning of dose to minimise constipation
Can be used as a regular medication or PRN basis
Aim to produce a comfortable, regular, soft well formed stool

31
Q

How do bulk forming laxatives work?

A

Contain soluble fibre and add bulk to stool, retain fluid in stool, stimulate peristalsis and have stool softening properties

32
Q

Examples of bulk forming laxatives?

A

Ispaghula husk and methylcellulose:

  1. Must not be taken immediately before bed
  2. Ensure adequate fluid intake to prevent intestinal obstruction
  3. Can take 2-3 days to take effect
33
Q

Osmotic laxatives…

A

Can aggravate bloating and abdominal pain

Macrogols act quickly and can use as needed

34
Q

What is linaclotide?

A

A once daily guanylate cyclase C receptor agonist that also increases intestinal fluid secretion

NICE recommend if optimal/maximal doses of laxatives from diff classes are ineffective and they have had constipation for at least 12 months

Review after 12 weeks

Pharmacology (19 decks)

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