Other Intestinal Disorders Flashcards
What is IBS?
Recurrent abdominal discomfort or pain, chronic for > 3 months, occurring on average at least one day per week; and has two of the three:
- Related to defecation
- Association with change in frequency of stool
- Association with change in consistency of stool
Is there an anatomical cause that can be found on labs, XRays, or biopsies in IBS?
No
What are the physiologic factors of IBS?
- Altered intestinal motility
- Increased intestinal sensitivity (visceral hyperalgesia)
- Various genetic and environmental factors
- Hormonal fluctuations (women)
- Psychosocial factors
Rectal insensitivity can be associated with what physiologic time in women?
Menses
When is the typical onset of IBS?
Begins in adolescence/20’s
What are the common symptoms associated with IBS?
- Abdominal discomfort
- Discomfort related to defecation; often sx resolve after defecation
- Cramping
Do bouts of IBS typically rouse patient from sleep?
No
What does a DRE test for?
Occult blood in the stool
What is FODMAP?
Diet that exclude diarrhea-producing foods
When treating constipation with fiber supplementation what is critically important for the patient?
Hydration
What are some diet modifications in the treatment of IBS?
- Small meals, eating slowly
- Reduce beans, cabbage, and other fermentable foods
- Reduce sweeteners
- Low fat diet
- Hydration
- Dietary fiber supplements
What are the three medications that can be used to treated IBS-C?
- Lubiprostone
- Linaclotide
- Plecanatide
What are the medications that can be used to treat IBS-D?
- Diphenoxylate or Loperamide
- Rifaximin
- Alosetron
- Elexadoline (need special license to prescribe)
What is the drug name for Miralax?
Polyethylene glycol laxative
What symptom of IBS can probiotics be helpful in alleviating?
Bloating
What are the symptoms associated with lactose intolerance?
Diarrhea
Abdominal distention
Flatulence
What is the most common type of lactose intolerance?
Acquired lactose deficiency
What is the clinical presentation of lactose intolerance in children?
Diarrhea after ingesting a significant amount of milk; not gaining weight
What is the clinical presentation of lactose intolerance in adult?
Watery diarrhea, bloating, excessive flatus, nausea, borborygmi, abdominal cramps after ingesting lactose
What is the preferred test for diagnosing lactose intolerance?
Hydrogen breath test (but doesn’t have to be completed if high clinical suspicion)
What is the treatment for lactose intolerance?
Avoid dietary sugars
Enzyme supplements
What supplement should patients with lactose intolerance take?
Calcium
What is non-ulcer dyspepsia?
Dyspeptic symptoms with no abnormalities on PE and EGD and/or other evaluation
Alternating constipation and diarrhea with dyspepsia suggests what two possible etiologies?
IBS or Excessive use of OTC
What are ulcer-like symptoms?
Pain localized in epigastrium, occurs before meals, partially relieved by food, antacids, or H2 blockers
What bacteria causes non-ulcerative dyspepsia and can increase risk of cancer?
H. pylori
What is the treatment for non-ulcer dyspepsia?
Treat specific symptoms
*symptoms can be treated with PPI’s, H2 blockers, or cytoprotective agent
What is the role of treatment with TCA’s in non-ulcer dyspepsia?
Alter sensory perception
Is acute constipation more suggestive of an organic or functional cause?
Organic
Excessive straining may contribute to anorectal pathology which may include
Hemorrhoids
Anal fissure
Rectal prolapse
Syncope
What is the normal transit time of food to pass through the entire GI system?
35 hours
What is the treatment for constipation?
Trial of fiber and/or over the counter laxatives
If trial of treatment fails in constipation what is the next step?
Measure colonic transit times with radiopaque markers (Sitz markers)
What patient cohorts is laxative abuse more likely?
- Eating disorders
- Elderly who continue treatment after constipation ceased
When prescribing opioids what should be co-prescribed to be started at the same time?
Laxatives
What is the etiology of opioid induced constipation?
Opioids inhibit gastric emptying and peristalsis in GI tract, delays absorption of meds and increased absorption of fluid
What are the prescribed pharmacologic treatments for OIC?
- Methylnaltrexone bromide (Relistor)
- Lubiprostone (Amitiza)
