Irritable bowel syndrome

Question 1

Etiology

Answer 1

1. Generally unknown
2. Altered bowel motility
3. Visceral hypersensitivity
4. Psychosocial

Question 2

Diagnostic criteria

Answer 2

1. Rome III criteria of recurrent abdominal pain or discomfort for at least 3 days per month for the last 3 months, associated with two or more of the following symptoms:
   a. pain is relieved by defecation
   b, onset of pain is associated with a change in bowel frequency (either diarrhoea or constipation)
   c. onset of pain is associated with a change in appearance of the stool (loose, watery or pellet-like).

Question 3

Investigations

Answer 3

1. No diagnostic
2. FBC
3. Celiac serology
4. CRP

Question 4

Alarm symptoms

Answer 4

1. > 50
2. FHx
   Bowel Ca
   Celiac
   IBD
3. Abnormal clinical findings
   Abdominal exam
   Severe, large volume diarrhea
   Rectal bleeding
   Weight loss ++
   Steatorrhea
   Vomiting or severe pain

Question 5

Management

Answer 5

1. Therapeutic relationship, education reassurance
2. Chronic and relapsing
3. Dietary modifications
   Low wheat
   Low lactose
   Low FODMAP->8 week trial
4. Symptom diary
5. CBT, hypnotherapy
6. ++Diarrhea->loperamide
7. Constipation
   Hydration
   Fruits, vegetables, fibre
   Behavioural
   Laxatives->bulking (psyllium/isaphalga), osmotic(macrogol Movicol, lactulose syrup), stimulant (bisacodyl, senna)
8. Abdominal pain
   Hyoscine butylbromide
   Mebeverine
   Peppermint oil
9. Amitriptyline
10. Citalopram or fluoxetine