Other Intestinal disorders Flashcards
What is recurrent abdominal discomfort of pain for >3months
IBS (irritable bowel disease)
what are the characteristics of IBS
2 of the following
- relation to defecation
- association with change in frequency of stool
- association with change in consistency of stool
what are physiologic factors of IBS
altered intestinal motility
increased intestinal sensitivity (visceral hyperalgesia)
various genetic and environmental factors
hormonal fluctuations affect bowel functions in women; rectal sensitivity during menses
what is the clinical presentation of IBS
begins adolescence/20s
abdominal discomfort
often triggered by food/stress
how is IBS diagnosed/worked up
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
what are red flags for IBS workup
older age
fever
weight loss
rectal bleeding
vomiting
What is the Rome criteria
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
what is the treatment of IBS
supportive/understanding, diet management, drug therapy
what is essential for effectively managing IBS
effective therapeutic relationship
what is steatorrhea
fecal fat - small floating fecal matter
what are drug therapy options for IBS
directed toward dominant symptoms
anticholinergics (hyoscyamine)
what are the medications for diarrhea-predominant IBS (IBS-D)
diphenoxylate
rifaximin(Abx)
alosterone
eluxadoline
What are drug therapy for constipation-predominated IBS (IBS-C)
Lubiprostone
linaclotide
plecanatide
what is the inability to digest certain carbohydrates due to lack of one or more intestinal enzymes
lactose intoleracne
what is carbohydrate intolerance
malabsorption syndrome
what are common symptoms of lactose intolerance
diarrhea, abdominal distention, flatulence
how is lactose intolerance diagnosed
clinical
hydrogen (H2) breath tests
what is the treatment of lactose intolerance
removal of causative carbohydrate from diet/supplement enzyme
what is the preferred test for lactose intolerance workup
hydrogen breath tests
what do lactose intolerance patients need to take
calcium supplements (1200-15000mg/day
what is dyspepsia
sensation of pain/discomfort in upper abd; often recurrent
described as indigestion, gassiness, early satiety, postprandial fullness, gnawing, burning
what is non-ulcer dyspepsia (functional dyspepsia)
dyspeptic symptoms with no abnormalities on FE or EDG and/or other evaluations
what are red flags of non-ulcer dyspepsia
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
what is the concern with a single, acute episode of dyspepsia
we need to rule out acute coronary ischemia
if relieved by rest r/o angina
what is the treatment of non-ulcer dyspepsia
tx specific conditions if present
symptoms treated with PPIs, H2 blockers, or cyroprotective agent
drugs that alter sensory perception may be helpful (TCAs)
what are red flags of constipation
distended, tympanitic abdomen
vomiting
blood in stool
weight loss
severe constipation of recent onset/worsening in older patients
what are findings of mechanical obstructions
tense
distended
tympanitic abdomen
esp. if n/v
what are findings of chronic aka functional constipation
modest abd discomfort suggests slow transit constipation; excessive straining or prolonged or unsatisfactory defecation
what are questions to ask with acute constipation
new med? diet changes?
what are the findings of fecal impaction
cramps
pass watery mucus or fecal material around impacted mass, mimicking diarrhea (overflow diarrhea)
what can inhibit gastric emptying and peristalsis in Gi tract
opioid medications - can delay absortpion of meds and increase absoprtion of fluids
what is the presentation of OIC
bloated sensation
constipation or diarrhea or alternating episodes
N/v
fecal impaction and use of digital evacuation
poor QOL
what is the treatment of OIC
increased dietary fiber, fluid intake, physical exercise
if rx opioids, consider prophylactic tx for constipation
What is Methylnaltrexone bromide (relistor)
first available peripherally acting opiate anatagonist used to treat OI
subQ better than PO
what patients should not used methylnaltrexone bromide
pts with PUD, diverticulosis, colon CA or obstruction
What is Lubiprostone (amitiza)
US approved for OIC
results in increased tone, enhances peristaliss and increased acceleration of small bowel and colonic transit times
what is normal transit time
35 hours
