Irritable bowel Syndrome

Question 1

probable aetiology

Answer 1

due to disorders of intestinal motility or enhanced visceral perception

‘brain-gut’ axis

Question 2

History of symptoms

Answer 2

chronic, >6 months,

exacerbated by stress, menstruation or gastroenteritis

Question 3

signs

Answer 3

Examination often normal
general abd tenderness
Examination rectal/abd mass

Question 4

Criteria

Answer 4

Pain is either relieved by defecation or associated with altered stool form or bowel frequency (constipation and diarrhea may alternate)

AND ≥2 of: urgency, incomplete evacuation, abd bloating/distension, mucous PR, worsening of symptoms after food.

Question 5

Diagnostic tets

Answer 5

normal bloods

initial: coeliac serology (tTG, IgA Endomesial antibodies)
further: faecal calprotectin, colonoscopy, CA125, TSH

Question 6

DDx

Answer 6

coeliac disease, lactose intolerance, bile acid malab, IBD, colorectal cancer

Question 7

Tx constipation

Answer 7

avoid insoluble fibre

Laxatives e.g. bisacodyl

Question 8

Tx diarrheoa

Answer 8

avoid sorbitol sweeteners

bulking agent + loperamide (an anti motility agent) after each lose stool

Question 9

Tx pain

Answer 9

oral antispasmodics (a.k.a anticholinergics)

e.g. benzatropine

block ACh in the brain

Question 10

Tx psychological symptoms

Answer 10

CBT, hypnosis

Question 11

Name a tricyclic antidepressant and when you’d use it

+ its main SE

Answer 11

amitriptyline

when nothing else works

SE: drowsiness, 4-6 weeks to take effect

NOT for depression

Question 12

epidemiology

Answer 12

10-20%

F>M