Lecture 30 - Irritable Bowel Syndrome and Inflammatory bowel disease

Question 1

Diagnosing functional problem?

Answer 1

diagnosis of exclusion, weighing the symptom complex and ruling out other diseases with symptoms by ruling out pathologies

Question 2

Symptoms of IBS?

Answer 2

swinging boel habit, abdom. pain relieved w defaecation, mucus passing, bloating, excessive flatus

Question 3

Alarm (contradictory) symptoms?

Answer 3

40+, short history, nocturnal behaviour, bleeding, anaemia, weight loss, vomiting

Question 4

Pathophysiology components of IBS?

Answer 4

Altered gut motility, visceral hypersensitivity, peripheral sensitisation, central sensitisation

Question 5

Mechanisms of visceral sensitivity?

Answer 5

central pain processing, spinal cord gate control, stress affecting brain-gut communication

Question 6

IBS treatments?

Answer 6

Conventional, dietry, natural, lifestyle

Question 7

Conventional treatments?

Answer 7

fibre supplements, laxatives, anti-motility drugs, low-dose tricyclics

Question 8

FODMAP definition?

Answer 8

fermentable oligo- di- monosaccharides and polyols

Question 9

Lifestyle advice for IBS?

Answer 9

regular unhurried meals, low stress, adequate sleep, cognitive behavioural therapy

Question 10

Genetics of Inflammatory Bowel Disease?

Answer 10

more important in chron’s vs. ulcerative colitis, majority of cases however w no family history

Question 11

Environmental factors of IBD?

Answer 11

developed countries w lower immunity, smoking increase risk of CD but decrease inflammation of UC

Question 12

Pathophysiology of IBD?

Answer 12

disruption of epithelial barrier, causing dysregulation of immune system leading to inflammation; pathogenic microbe presence also possible

Question 13

UC pathology?

Answer 13

starts in rectum spreads to rest of colon only, mucosal inflammaton with no macroscopic ulceration (except serious cases)

Question 14

UC histology?

Answer 14

mucosal inflammation only, crypt distortion and atrophy, neutrophil presence, goblet cell loss

Question 15

UC clinical presentations?

Answer 15

bloody diarrhoea, bowel urgency, abdom. pain (fever, weight loss)

Question 16

CD pathology?

Answer 16

discontinuous skip lesions anywhere in bowel, small ulcers of mucosa progress to deep penetrating ulcers w fissuring

Question 17

CD histology?

Answer 17

inflammation of whole wall, granuloma presence

Question 18

CD clinical presentationss?

Answer 18

depends on location - inflammation, stricturing, fistulising, perianal

Question 19

Extra-intestinal manifestations of IBD?

Answer 19

more common in chron’s - eyes, mouth, kidneys, skin, liver, biliary tracts, joints, circulation

Question 20

Treatments of IBD?

Answer 20

5-ASA, steroids, immunosuppressants, biologics

Question 21

Surgery decision?

Answer 21

failure of medical treatment, treatment of complications e.g. obstructions, colectomy curative for UC

Question 22

Differentiating IBD from IBS?

Answer 22

far less common, no alternating bowel habit, bleeding, alarm symptoms, blood test abnormailities, peri-anal symptoms