Lecture 30 - Irritable Bowel Syndrome and Inflammatory bowel disease Flashcards
Diagnosing functional problem?
diagnosis of exclusion, weighing the symptom complex and ruling out other diseases with symptoms by ruling out pathologies
Symptoms of IBS?
swinging boel habit, abdom. pain relieved w defaecation, mucus passing, bloating, excessive flatus
Alarm (contradictory) symptoms?
40+, short history, nocturnal behaviour, bleeding, anaemia, weight loss, vomiting
Pathophysiology components of IBS?
Altered gut motility, visceral hypersensitivity, peripheral sensitisation, central sensitisation
Mechanisms of visceral sensitivity?
central pain processing, spinal cord gate control, stress affecting brain-gut communication
IBS treatments?
Conventional, dietry, natural, lifestyle
Conventional treatments?
fibre supplements, laxatives, anti-motility drugs, low-dose tricyclics
FODMAP definition?
fermentable oligo- di- monosaccharides and polyols
Lifestyle advice for IBS?
regular unhurried meals, low stress, adequate sleep, cognitive behavioural therapy
Genetics of Inflammatory Bowel Disease?
more important in chron’s vs. ulcerative colitis, majority of cases however w no family history
Environmental factors of IBD?
developed countries w lower immunity, smoking increase risk of CD but decrease inflammation of UC
Pathophysiology of IBD?
disruption of epithelial barrier, causing dysregulation of immune system leading to inflammation; pathogenic microbe presence also possible
UC pathology?
starts in rectum spreads to rest of colon only, mucosal inflammaton with no macroscopic ulceration (except serious cases)
UC histology?
mucosal inflammation only, crypt distortion and atrophy, neutrophil presence, goblet cell loss
UC clinical presentations?
bloody diarrhoea, bowel urgency, abdom. pain (fever, weight loss)
CD pathology?
discontinuous skip lesions anywhere in bowel, small ulcers of mucosa progress to deep penetrating ulcers w fissuring
CD histology?
inflammation of whole wall, granuloma presence
CD clinical presentationss?
depends on location - inflammation, stricturing, fistulising, perianal
Extra-intestinal manifestations of IBD?
more common in chron’s - eyes, mouth, kidneys, skin, liver, biliary tracts, joints, circulation
Treatments of IBD?
5-ASA, steroids, immunosuppressants, biologics
Surgery decision?
failure of medical treatment, treatment of complications e.g. obstructions, colectomy curative for UC
Differentiating IBD from IBS?
far less common, no alternating bowel habit, bleeding, alarm symptoms, blood test abnormailities, peri-anal symptoms
