L17: IBS

Question 1

Def of IBS

Answer 1

Question 2

Epidemeology of IBS

Answer 2

• More common in Females
• Peak: 30 - 40 years.

Question 3

Pathophysiology of IBS

Answer 3

Question 4

Most accepted pathophysiology of IBS

Answer 4

Visceral hypersensitivity: increased sensitivity to abdominal distension

Question 5

Types of IBS

Answer 5

Question 6

CP of IBS

Answer 6

Question 7

Rome IV Criteria for IBS

Answer 7

Question 8

Symptoms of IBS

Answer 8

 Altered bowel habits.
 Abdominal pain.
 Abdominal distention

Question 9

Altered Bowel Habits in IBS

Answer 9

• Constipation
• Diarrhea
• Postprandial urgency

Question 10

Constipation in IBS

Answer 10

characterized by pellet-like stools associated with straining, sense of incomplete evacuation, and passage of mucus

Question 11

Diarrhea in IBS

Answer 11

described as frequent, loose stools that may be associated with urgency (stool volume is normal)

Question 12

Post-Prandial Urgency in IBS

Answer 12

is common, as is alternation between constipation and diarrhea.

Question 13

Characteristically, one feature predominates in a single patient, but significant variability exists among patients.

Answer 13

..

Question 14

Characters of abdominal Pain in IBS

Answer 14

• Frequently is diffuse without radiation.
• Acute episodes of sharp pain are often superimposed on a more constant dull ache.

Question 15

Site of of abdominal Pain in IBS

Answer 15

Common sites of pain include the lower abdomen, specifically the left lower quadrant.

Question 16

What Increases abdominal Pain in IBS?

Answer 16

Meals may precipitate pain

Question 17

What Decreases abdominal Pain in IBS?

Answer 17

Defecation commonly improves pain.

Question 18

Dx of IBS

Answer 18

Question 19

Red flags in IBS

Answer 19

⇒ Older age
⇒ Weight loss
⇒ Rectal bleeding
⇒ Vomiting
⇒ Fever

Question 20

Additional Symptoms in IBS

Answer 20

 Excess mucus
 Dyspepsia & heart burn
 Urinary urgency
 Comorbid fibromyalgia
 Stress related

Question 21

Investigations in IBS

Answer 21

Question 22

TTT of IBS

Answer 22

• General Measures
• Symptoms-Guided TTT
• Probiotics & Antibiotics

Question 23

General measures in TTT of IBS

Answer 23

 Reassurance, explanation, support, aim for realistic goals

 Relaxation therapy, biofeedback, stress reduction, exercise

 Low FODMAP diet for pain, bloating gas.

Question 24

TTT of Pain in IBS

Answer 24

• Antispasmodic medication before meals (e.g. hyoscine, low level evidence)
• Increase dietary fiber (bran or psyllium)
• Tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI)

Question 25

TTT of IBS with diarrhea (IBS-D)

Answer 25

 Loperamide (Imodium)

 Diphenoxylate (Lomotil)

 Cholestyramine

Question 26

TTT of IBS with constipation (IBS-C)

Answer 26

 Increase fiber in diet

 Linaclotide

 Laxatives (help more with the constipation than the pain)

Question 27

Probiotics & antibiotics in IBS

Answer 27

 Rifaximin: Nonabsorbable antibiotics, decreasing bloating

 Probiotics: for bloating and flatulence.

 Fecal transplantation

Question 28

Done

Answer 28

…