Irritable Bowel Syndrome - Week 5 Flashcards
**What are the three key symptoms/signs of IBS?
- Abnormal stool frequency
- Abnormal stool form (lumpy/hard or loose/watery stool)
- Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)
- Bloating or feeling of abdominal distention (was removed in Rome III, but still relevant complaint)
How does the menstrual cycle and post-menopausal status affect IBS symptoms?
- IBS is most prevalent during the menstruation years
- Symptoms are the most severe during the postovulatory and premenstrual phases
- Pregnancy appears to temporarily improve IBS symptoms
- Oral estrogen and progesterone do not seem to have any effect on IBS symptom levels
- Irregular menstruation has no association with IBS symptom severity
- Endometriosis increases bloating symptoms, but not other symptoms in IBS
- Reports of abdominal bloating after menopause occurred for those not receiving HRT
What stool tests may reveal infectious etiologies for IBS?
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What are the alarm signs (red flags) in IBS?
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What non-invasive tests are used to determine the need for colonoscopy to rule out more serious diagnoses in patients with IBS-like symptoms?
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**What are seven clinical indicators that increase the chances of SIBO being the etiology for IBS?
- When a patient reports dramatic transient improvement in IBS/GI symptoms after Abx Rx
- When a patient reports worsening of GI symptoms from probiotics (prebiotics)
- When a patient reports fiber worsens their constipation (and other GI symptoms)
- When a celiac patient reports insufficient improvement from a strict gluten-free diet
- When a patient develops chronic GI symptoms after taking proton pump inhibitors
- When a patient develops chronic GI symptoms after taking opiates
- When a patient develops chronic GI symptoms after taking (long-term) broad spectrum antibiotics
- When a patient has chronic low ferritin or iron with no other cause
- When a patient develops post-infectious IBS
What are the physiological mechanisms by which bacterial overgrowth is normally prevented?
- Presence of adequate upper GI secretions
> Gastric acid
> Pancreatic exocrine enzymes and bicarb
> Bile acids
> MALT
> HCl has bacteriocidal effect
> Pepsin has proteolytic effect - Normal GI anatomy
> Promotes clearance - Intact and functional mucosal brush border
> Disaccharides and peptidases finish chemical digestion - Motility (main etiologic factor!)
> MMC sweeps any undigested foods and organisms to the ICV
> Anything that decreases MMC increases SIBO - Functional ileocecal valve keeps a one-way flow
- Normal blood sugar levels
What are the typical effects of H2 and CH4 on gastrointestinal motility?
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Which gas produced by SIBO is associated with increasing symptoms of fibromyalgia?
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What is the likely mechanism by which SIBO leads to fat soluble vitamin deficiencies?
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What are the four main categories of treatment for SIBO?
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What is the mechanism of action of enteric coated menthol for IBS?
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How is enteric coated menthol used for IBS?
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