Other Intestinal disorders

Question 1

What is recurrent abdominal discomfort of pain for >3months

Answer 1

IBS (irritable bowel disease)

Question 2

what are the characteristics of IBS

Answer 2

2 of the following
- relation to defecation
- association with change in frequency of stool
- association with change in consistency of stool

Question 3

what are physiologic factors of IBS

Answer 3

altered intestinal motility
increased intestinal sensitivity (visceral hyperalgesia)
various genetic and environmental factors
hormonal fluctuations affect bowel functions in women; rectal sensitivity during menses

Question 4

what is the clinical presentation of IBS

Answer 4

begins adolescence/20s
abdominal discomfort
often triggered by food/stress

Question 5

how is IBS diagnosed/worked up

Answer 5

clinical evaluation
screening for organic causes: basic lab tests and sigmoidoscopy or colonoscopy
dx based: characteristic bowel patterns, time/character of pain, exclusion of other disease via PE/testing

Question 6

what are red flags for IBS workup

Answer 6

older age
fever
weight loss
rectal bleeding
vomiting

Question 7

What is the Rome criteria

Answer 7

requiring presence of abd pain, at least 1 day/week for last 2 months plus > 2 of the following:
- pain related to defecation
-pain associated with change in frequency of defication
-pain associated with change in consistency of stool

Question 8

what is the treatment of IBS

Answer 8

supportive/understanding, diet management, drug therapy

Question 9

what is essential for effectively managing IBS

Answer 9

effective therapeutic relationship

Question 10

what is steatorrhea

Answer 10

fecal fat - small floating fecal matter

Question 11

what are drug therapy options for IBS

Answer 11

directed toward dominant symptoms
anticholinergics (hyoscyamine)

Question 12

what are the medications for diarrhea-predominant IBS (IBS-D)

Answer 12

diphenoxylate
rifaximin(Abx)
alosterone
eluxadoline

Question 13

What are drug therapy for constipation-predominated IBS (IBS-C)

Answer 13

Lubiprostone
linaclotide
plecanatide

Question 14

what is the inability to digest certain carbohydrates due to lack of one or more intestinal enzymes

Answer 14

lactose intoleracne

Question 15

what is carbohydrate intolerance

Answer 15

malabsorption syndrome

Question 16

what are common symptoms of lactose intolerance

Answer 16

diarrhea, abdominal distention, flatulence

Question 17

how is lactose intolerance diagnosed

Answer 17

clinical
hydrogen (H2) breath tests

Question 18

what is the treatment of lactose intolerance

Answer 18

removal of causative carbohydrate from diet/supplement enzyme

Question 19

what is the preferred test for lactose intolerance workup

Answer 19

hydrogen breath tests

Question 20

what do lactose intolerance patients need to take

Answer 20

calcium supplements (1200-15000mg/day

Question 21

what is dyspepsia

Answer 21

sensation of pain/discomfort in upper abd; often recurrent
described as indigestion, gassiness, early satiety, postprandial fullness, gnawing, burning

Question 22

what is non-ulcer dyspepsia (functional dyspepsia)

Answer 22

dyspeptic symptoms with no abnormalities on FE or EDG and/or other evaluations

Question 23

what are red flags of non-ulcer dyspepsia

Answer 23

acute episode with dyspnea, diaphoresis or tachycardia
anorexia
N/v
weight loss
blood in the stool
dysphagia or odynophagia
failure to respond to H2 blockers or PPIs

Question 24

what is the concern with a single, acute episode of dyspepsia

Answer 24

we need to rule out acute coronary ischemia
if relieved by rest r/o angina

Question 25

what is the treatment of non-ulcer dyspepsia

Answer 25

tx specific conditions if present
symptoms treated with PPIs, H2 blockers, or cyroprotective agent
drugs that alter sensory perception may be helpful (TCAs)

Question 26

what are red flags of constipation

Answer 26

distended, tympanitic abdomen
vomiting
blood in stool
weight loss
severe constipation of recent onset/worsening in older patients

Question 27

what are findings of mechanical obstructions

Answer 27

tense
distended
tympanitic abdomen
esp. if n/v

Question 28

what are findings of chronic aka functional constipation

Answer 28

modest abd discomfort suggests slow transit constipation; excessive straining or prolonged or unsatisfactory defecation

Question 29

what are questions to ask with acute constipation

Answer 29

new med? diet changes?

Question 30

what are the findings of fecal impaction

Answer 30

cramps
pass watery mucus or fecal material around impacted mass, mimicking diarrhea (overflow diarrhea)

Question 31

what can inhibit gastric emptying and peristalsis in Gi tract

Answer 31

opioid medications - can delay absortpion of meds and increase absoprtion of fluids

Question 32

what is the presentation of OIC

Answer 32

bloated sensation
constipation or diarrhea or alternating episodes
N/v
fecal impaction and use of digital evacuation
poor QOL

Question 33

what is the treatment of OIC

Answer 33

increased dietary fiber, fluid intake, physical exercise
if rx opioids, consider prophylactic tx for constipation

Question 34

What is Methylnaltrexone bromide (relistor)

Answer 34

first available peripherally acting opiate anatagonist used to treat OI
subQ better than PO

Question 35

what patients should not used methylnaltrexone bromide

Answer 35

pts with PUD, diverticulosis, colon CA or obstruction

Question 36

What is Lubiprostone (amitiza)

Answer 36

US approved for OIC
results in increased tone, enhances peristaliss and increased acceleration of small bowel and colonic transit times

Question 37

what is normal transit time

Answer 37

35 hours