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Gastroenterology > Irritable Bowel Syndrome > Flashcards

Irritable Bowel Syndrome Flashcards

1
Q

A functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit, and with features of disordered defecation.

A

IBS

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2
Q

Diagnostic Criteria of IBS

A
  1. Recurrent abdominal pain or discomfort at least 3 days per month in the last three months; onset > 6 months prior to dx.
  2. Assc with 2+ of:
    - - Improvement with Defecation
    - - Change in stool frequency
    - - Change in stool form
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3
Q

______ patients in North America have IBS

A

10-15%

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4
Q

This type of Irritable Bowel Syndrome is predominantly presenting with constipation. How common is this type in IBS patients?

A

IBS-C; 33-50% of IBS patients

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5
Q

This type of Irritable Bowel Syndrome is predominantly presenting with constipation. How common is this type in IBS patients?

A

IBS-D; ~33% of IBS patients

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6
Q

This type of Irritable Bowel Syndrome is presents with constipation and diarrhea alternatively.

A

IBS-A

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7
Q

What is the biggest difference between IBS-C and Chronic Constipation?

A

Prolonged Abdominal Pain

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8
Q

What are clinical signs/symptoms of IBS-C?

A
  1. Elevated pain scores

2. Marked effect on activities of daily living

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9
Q

Proposed Etiologies of IBS:

A
  1. Altered intestinal motility
  2. Post-infectious, after episode of gastroenteritis
  3. Visceral Hypersensitivity (distention and gas)
  4. Distubances in gut flora (bacterial overgrowth and increased mucosal permeability)
  5. Mast cell activation with histamine, tryptase release.
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10
Q

Is IBS more common in Women or Men?

A

Women!

2-4:1
Is this because of their increased healthcare seeking behavior? Lord knows.

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11
Q

How do women present in clinic with IBS?

A

More pain and psychological disorders. Tend to feel misunderstood by healthcare providers.

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12
Q

What psych illnesses are associated with IBS (comorbidity)?

A
  1. Depression
  2. Health Anxiety
  3. Neuroticism
  4. Hx of eating d/o (anorexia/bulimia)
  5. Adverse life events (Sex/Phys Abuse)
  6. Reduced QOL
  7. Increased Healthcare Seeking
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13
Q

When taking a History, what would you ask for a pt with suspected IBS?

A
  1. Describe change in bowel habits, frequency, and stool consistency
  2. Abdominal Pain, Bloating, when, where, triggers?
  3. Describe assc. Symptoms
  4. Assc with meals?
  5. Any recent illness prior to onset of symptoms?
  6. Family Hx?
  7. Preggo?
  8. Gyn probs? Fibroids, endometriosis?
  9. Hx of eating disorder
  10. Hx of phys/sex abuse?
  11. PTSD
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14
Q

What history features will POUND THE ALARM? (Red Flags)

A
  1. 50+ yo or acute gradual onset in elderly
  2. Hx of anemia/Fe Deficiency
  3. Unintentional weight loss (cachexia)
  4. Family Hx of colon cancer, GI malignancy, or IDB.
  5. Nocturnal Symptoms
  6. Fevers
  7. Oral apthous ulcers
  8. Hematochezia
  9. Opthalmic inflammation (iritis/scleritis)
  10. Dermatologic conditions (eryethema nodosum, pyoderma gangrinosum)
  11. Inflammatory arthritis
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15
Q

I am a stool that is sausage-shaped and lumpy. Who am I?

A

Type 2

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16
Q

I am a stool that watery with no solid pieces. Who am I?

A

Type 7

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17
Q

I am a stool that is fluffy with ragged edges (mushy). Who am I?

A

Type 6

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18
Q

I am a stool that is separated hard lumps like nuts and are hard to pass. Who am I?

A

Type 1

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19
Q

I am a stool that is sausage-shaped with cracks on the surface. Who am I?

A

Type 3

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20
Q

I am a stool that is a soft blob with clear-cut edges that is passed easily. Who am I?

A

Type 5

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21
Q

I am a stool that is a soft smooth sausage-like snake.. Who am I?

A

Type 4

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22
Q

What does a focused physical exam of someone with suspected IBS be like?

A
  1. Abdominal Exam
  2. Digital Rectal Exam with Perineal inspection
  3. Pelvic Exam, when indicated
  4. Assessment of Neurologic Function (anocutaneous reflex, Deep tendon reflexes, lower extremities)
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23
Q

What are the diagnostic tests to dx IBS?

A
  1. CBC, CMP, TSH, ESR, Tissue tTG-Ab IgA
  2. Stool analysis (lactoferrin or calprotectin), stool culture, O&P, Giardia, C. diff, Hemoccult
  3. US Abdomen/Pelvis, dependent of symptoms
  4. Colonoscopy if >50 years or + FH IBD/CRC
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24
Q

Non-pharmacologic therapies of IBS?

A
  1. Dietary Modification (Avoid potential triggers like caffeine, alcohol, sorbitol, high fiber foods, high fructose corn syrup, lactose, excess gluten)
    * **High fiber and low gluten may help some patients
  2. Priobiotics
  3. Behavioral Modification
  4. Cognitive Behavioral therapy
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25
Q

What is FODMAPS?

A

Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

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26
Q

What is the role of FODMAPS in IBS?

A

Rapidly fermentable short chain carbs assc with abdominal pain, bloating/gas and altered bowel habits.

Fermentation also has osmotic effects.

27
Q

What foods should we avoid in a person with IBS (in regards to FODMAPS)?

A
  1. Fructose (apples, pears, peaches, mangoes)
  2. Lactose (cow, goat, sheep milk, ice cream)
  3. Polyols (asparagus, broccoli, brussel sprouts, onions)
  4. Fructans/Galactans (cherries, plums, avocado)
28
Q

What foods should we let patients with IBS consume (in regards to FODMAPS)?

A
  1. Bananas, Blueberry, Kiwi, citrus
  2. Lactose-free milk, rice milk, sorbet, gelati
  3. Carrot, Celery, Corn, Green beans, Tomato
  4. Honeydew melon, Citrus, Raspberries
29
Q

What are some common probiotics that might help with IBS and what have they been shown to do?

A
  1. Bifidobacteria infantis
  2. Lactobacillis GG
  3. L. acidophilus (alone or in combo)

– Mixed results shown for reducing global symptom scores, diarrhea, or pain.

30
Q

What types of behavioral modification would assist in IBS treatment?

A
  1. Relaxation Techniques
  2. Biofeedback
  3. Hypnosis
31
Q

What types of cognitive behavior therapy would assist in IBS treatment

A
  1. Coping with chronic illness and stress

2. Treating concomitant anxiety, depression

32
Q

These are anti-spasmodic medications that can be used to treat IBS:

A
  1. Dicyclomine
  2. Hyoscyamine

– May decrease the pain of colonic spasm, but may worsen constipation. (Insufficient data in IBS-C)

33
Q

These medications involve serotonin and its receptors influence on GI motility and hypersensitivity.

A

SSRIs

34
Q

Serotonin is about how high in the gut?

A

90+%

35
Q

Where in the gut is serotonin commonly in?

A

Predominantly in the enterochromaffin cells of the enteric nervous system.

36
Q

What are the common SSRIs to know for IBS treatment?

A
  1. Fluoxetine
  2. Citalopram
  3. Paroxetine
37
Q

Are SSRIs helpful in the treatment of IBS?

A

Not at all, but I’m glad we know so much more about this. It is better used for depression.

38
Q

These drugs have been shown to be no better than a placebo at relieving global IBS symptoms.

A

Tricyclic Antidepressants (Amitriptyline, Nortriptyline)

39
Q

Using Tricyclic Antidepressants might cause:

A

Worsened Constipation, but may improve abdominal pain – despite the results saying it is no better than a placebo…

40
Q

These types of drugs can increase the volume of the stool.

A

Bulking Agents

41
Q

This is commonly found in metamucil. It can adversely cause bloating and some patients may actually be allergic. Also called Ispaghula Husk.

A

Psyllium

42
Q

These drugs may inhibit fluid absorption and soften your stools.

A

STOOL SOFTENERS! Such as Docusate Sodium.

Efficacy in IBS not well established

43
Q

What is an effective treatment in IBS-C that improves constipation by pulling fluid into the colon lumen. Although, there is lacking evidence for efficacy and tolerability in IBS.

A

Osmotic Laxatives (Lactulose 10-20 g/day)

44
Q

What is a common adverse effect of using Lactulose?

A

Flatulence and Intestinal Cramps

45
Q

In the 14 day treatment period, a significant _______ in bowel movements was reported with polyethylene glycol vs placebo

A

Increase! Polyethylene glycol has been shown to be an effective Osmotic Laxative.

46
Q

This is a medication for IBS-C Therapy that is a selective chloride channel receptor agonist (CIC2) and it enhances intestinal fluid secretion without altering serum electrolyte levels.

A

Lubiprostone

47
Q

How is Lubiprostone dosed?

A

Start at 8 mcg capsules BID WITH food (you can get nauseous on an empty stomach)

48
Q

Adverse effects of Lubiprostone?

A

Diarrhea and Nausea

49
Q

Goal of treatment with Lubiprostone?

A

Increased number of bowel movements per week and decreased abdominal pain/discomfort.

50
Q

This is a IBS-C therapy that is a guanylate cyclase-C agonist. It increases intestinal water AND electrolyte secretion thereby accelerating ascending colon transit.

A

Linaclotide

51
Q

Function of Linaclotide?

A

Improved abdominal pain and bowel movement frequency.

52
Q

Adverse Effects of Linaclotide?

A

Diarrhea

53
Q

Can you use Linaclotide for Chronic Constipation or is it a IBS-C drug only?

A

Used in both

54
Q

Dosing of Linaclotide in IBS-C patients

A

290 mcg at least 30 mins before the first meal

55
Q

Dosing of Linaclotide in CC patients

A

145 mcg qd (290 is no better than 145)

56
Q

This is a drug for IBS-D that acts as a opioid mu receptor agonist and decreases intestinal secretion. It is quickly absorbed too

A

Loperamide

57
Q

This is a medication for IBS-D that is an oral selective serotonin 5-HT3 antagonist. IT is approved for women with diarrhea (remember women commonly have IBS)

A

Alosetron

58
Q

Some adverse effects of Alosetron are?

A

Severe Constipation and Ischemic Cholitis

59
Q

This is a IBS-D medication that is gut-selective, non-absorbable antibiotic. Carries broad activity against Gram + and - anaerobes

A

Rifaximin

60
Q

Function of Rifaximin

A

Improved symptoms of diarrhea and bloating in short term clinical trials. – Dosing regimes for chronic clinical condition is unclear.

61
Q

IBS is characterized by:
A. Chronic diarrhea, weight loss, abdominal pain
B. Microcytic anemia, bloating, and diarrhea
C. Constipation, anal bleeding, rectal pain
D. Persistent and recurrent abdominal pain and abnormal bowel habits

A

D.

62
Q 
The proposed etiologies of IBS include all of the following except:
A. Visceral Hypersensitivity
B. Post-infectious
C. Microscopic Colitis
D. Intestinal Bacterial Overgrowth
A

C.

63
Q 
The following are common therapies for IBS except which of the following:
A. Loperamide
B. Mesalamine
C. Rifaximin
D. Nortriptyline
A

B.

Gastroenterology (12 decks)

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