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Year 3 > Irritable bowel syndrome (GI) > Flashcards

Irritable bowel syndrome (GI) Flashcards

1
Q

Define IBS.

A

Chronic condition characterised by abdominal pain associated with bowel dysfunction (e.g. change in stool frequency or form)

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2
Q

What is the pain in IBS often relieved by?

A

Defecation

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3
Q

What can IBS pain often be accompanied with?

A

Abdominal bloating

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4
Q

What demographic does IBS affect most?

A
  • F>M (2:1)
  • highest prevalence in people aged 20-39
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5
Q

What could be some contributory factors to IBS? (6)

A
  • inflammatory/immune system involvement (histology can show subtle alterations to gut-homing T lymphocytes + increased mast cells)
  • intestinal mucosa
  • bacterial overgrowth, bile acid malabsorption
  • gut hypersensitivity with enhanced perception of visceral type pain & dysregulation of brain-gut axis
  • triggers can be environmental (e.g. stress and emotional tension) or luminal (e.g. certain foods, bacterial overgrowth or toxins, gut distension)
  • precipitating dietary associations include caffeine, lactose-containing foods or fructose-containing foods
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6
Q

What are the clinical features of IBS? (7)

A
  • abdominal pain (cramping pain in lower/mid-abdomen >6months, relieved by defecation)
  • alteration of bowel habits associated with pain - diarrhoea, constipation or both
  • abdominal bloating or distension (relieved with defecation)
  • passage of mucus with stool
  • urgency of defecation
  • symptoms made worse by eating
  • no nocturnal symptoms
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7
Q

What is abdominal examination like in IBS?

A

Normal - could have tenderness in RLQ/LLQ but no other abnormalities

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8
Q

What are the ABC of IBS?

A
  • A - abdominal pain
  • B - bloating
  • C - change in bowel habit for >=6 months
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9
Q

What are some red flag symptoms for IBS? (4)

A
  • weight loss
  • anaemia
  • PR bleeding
  • late onset (>60)
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10
Q

What are some risk factors of IBS? (7)

A
  • physical and sexual abuse
  • PTSD
  • age <50
  • female sex
  • previous enteric infection
  • family history
  • stress
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11
Q

What is the 1st-line investigation for IBS?

A

FBC - should be normal
If anaemia or raised WBC = not IBS

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12
Q

What bloods (other than FBC) can we consider for IBS? (2)

A
  • CRP & ESR - rule out infection or inflammation (IBD)
  • serologic tests: anti-TTG antibodies (exclude coeliac)
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13
Q

What imaging can we consider for IBS? (2)

A
  • ultrasound - exclude gallstone disease
  • flexible sigmoidoscopy/colonoscopy - rule out IBD
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14
Q

What special tests can be considered for IBS?

A
  • faecal calprotectin - to exclude IBD (looks for inflammation - if low, IBD unlikely)
  • faecal occult blood - normal in IBS, positive in IBD or colorectal cancer
  • quantitative faecal immunochemical test (FIT): >=10mg of Hb/g indicates possible colorectal cancer
  • stool sample - exclude dyspepsia associated with H. pylori
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15
Q

What is faecal calprotectin used for?

A

To distinguish between IBS and IBD - if raised it indicates inflammation in bowel –> IBD

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16
Q

What is the main differential for IBS and what are the different features may this have?

A

IBD (Crohn’s & UC)

  • systemic symptoms - fever, fatigue
  • blood in faeces
  • raised faecal calprotectin
  • raised serum CRP&ESR
17
Q

What are some differentials for IBS?

A
  • Crohn’s disease - fatigue, diarrhoea, abdo pain, fever, rectal bleeding, oral ulcers, perianal skin tags, fistulae, abscesses, palpable mass in ileocaecal area, no mass present on DRE, faecal occult blood +ve
  • ulcerative colitis - bloody diarrhoea, Hx lower abdo pain, faecal urgency, erythema nodosum, acute arthropathy, Hx primary sclerosing cholangitis
  • lymphocytic and collagenous colitis
  • Coeliac disease - weight loss, early osteoporosis, iron deficiency anaemia, hypocalcaemia, elevated PT, anti-TTG antibodies
  • colon cancer
  • bowel infection (acute, Giardiasis = diarrhoea, nausea, bloating, steatorrhoea, stool exam)
  • non-Coeliac gluten sensitivity (negative anti-TTG)
  • bile acid malabsorption (bile acid binder can be used)
  • small bowel bacterial overgrowth (bloating, diarrhoea, cramps, altered motility, hydrogen breath testing)
18
Q

What kind of diagnosis is IBS?

A

Diagnosis of exclusion

19
Q

What diagnostic criteria can help diagnose IBS?

A

Rome IV criteria:
Recurrent abdominal pain, on average at least 1 day per week in the last 3 months and associated with 2+ of the following:
- related to defecation
- associated with a change in frequency of stool
- associated with a change in form (appearance) of stool

20
Q

What are the different Rome IV subtypes of IBS? (4)

A
  • IBS with constipation (IBS-C): hard/lumpy>25%, loose/watery<25%
  • IBS with diarrhoea (IBS-D): loose/watery>25%, hard/lumpy<25%
  • mixed IBS (IBS-M): hard/lumpy<25%, loose/watery<25%
  • unspecified IBS: insufficient abnormality of stool consistency to meet other criteria
21
Q

What lifestyle changes are there for IBS?

A
  • fibre (soluble fibre found in ispaghula, oat bran, barley, beans)
  • probiotics - actimel, yogurts, supplements
  • eliminate precipitating substances e.g. caffeine, lactose or fructose
  • stress management
  • education
  • reassurance
22
Q

What type of diet can IBS patients try?

A

Low FODMAP diet - Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols

23
Q

What do we give if constipation-predominant IBS?

A
  • laxative (polyethene glycol PEG)
  • 2nd line: secretagogue (serotonin receptor partial agonist) e.g. lubiprostone, linaclotide, plecanatide, tenapanor
24
Q

What do we give if diarrhoea-predominant IBS?

A

Antidiarrhoeal (loperamide is 1st line)

25
Q

What do we give if alternating constipation and diarrhoea IBS?

A

Laxative (PEG) + antidiarrhoeal (loperamide)

26
Q

What do we give if pain or bloating predominant in IBS?

A
  • antispasmodic (dicycloverine or hyoscyamine or peppermint oil)
  • if pain persists TCA (but can cause constipation) or SSRI (if constipated, also for depression)
27
Q

What is dermatitis herpetiformis in IBS treated with?

A

Dapsone

28
Q

What are some complications of IBS? (5)

A
  • diverticulosis risk
  • depression
  • sleep disorders
  • family relationship tension
  • lower urinary tract symptoms
29
Q

Describe the prognosis of IBS.

A
  • no long-term complications
  • however, the symptoms of IBS tend to recur for much of adulthood, particularly at times of stress, emotional difficulty or dietary indiscretions

Year 3 (148 decks)

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