Irritable Bowel Syndrome Flashcards

1
Q

What is IBS

A

Relapsing functional bowel disorder associated with a change in bowel habit -> No organic cause found
Group of symptoms/not specific

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2
Q

Describe stools in IBS

A

Hard, soft and mixed stool

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3
Q

Clinical presentation of IBS

A

Crampy abdominal pain relieved by defecation or wind
Altered bowel habit
Sensation of incomplete evacuation (tenesmus)
Abdominal bloating
Distension
Change in bowel habit i.e. increased or decreased frequency

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4
Q

Pathophysiology of IBS

A

Broadly unknown

No organic cause can be found

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5
Q

Aetiology of IBS

A

No structural lesion
Broadly unknown
Associated with psychological stress
Possibly related to increased sensitivity of the gut and problems digesting food

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6
Q

Epidemiology of IBS

A

More common in women
10-20% prevalence
age of onset often less than or around 40

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7
Q

Diagnosis of IBS

A

NOT a diagnosis of exclusion

*Coeliac screen

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8
Q

Treatment of IBS

A

Regular meals
Lots of fluids
Fibre depends on type; more with diarrhoea, less with constipation
Placebo has strong effect

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9
Q

Signs of IBS

A

examination may be normal, but general abdominal tenderness is common
insufflation or air during lower GI endoscopy (not usually needed) may reproduce pain

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10
Q

Management of IBS - when to refer patient

A

Uncertain of diagnosis
Changing symptoms
Refractory symptoms - stress or depression

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11
Q

Order of treatment

A

Should focus on controlling symptoms
Initially using lifestyle/dietary measures
Then cognitive therapy or pharmacotherapy if required

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12
Q

Treatment of constipation associated

A

Ensure adequate water and fibre intake
Promote physical activity
Simple laxatives

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13
Q

Treatment of diarrhoea

A

avoid sorbitol sweeteners, alcohol and caffeine
reduce dietary fibre content
encourage patients to identify their own ‘trigger foods’
try a bulking agent maybe with loperamide after each loose stool

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14
Q

Treatment of colic/bloating

A

Oral antispasmodics (e.g. mebeverine)

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15
Q

Treatment of psychological symptoms/visceral hypersensitivity

A

Emphasise the positive

Consider CBT

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16
Q

Conservative treatment

A

Education and avoidance of triggering factors e.g. decrease stress

17
Q

Medical treatment

A

Depends on symptoms; antimuscarinics, antispasmodics and antidepressants may play a role

18
Q

Complications

A

Depression and anxiety

19
Q

**Management of:
Pain/bloating
Constipation
Diarrhoea

A

Pain/bloating - Anti-spasmodic e.g. Buscopan
Constipation - Laxative e.g. Senna
Diarrhoea - Anti-motility e.g. Loperamide