Syndrome du côlon irritable et autres troubles fonctionnels

Question 1

What is syndrome du côlon irritable (SCI)?

Answer 1

It’s a trouble fonctionnel —> douleur abdominale, changement de selles

Non dû à des lésions organiques

NOT A PSYCHIATRIC condition

It’s an actual dx… Critères de Rome (not something that is dx when you can’t find anything else.. it’s am actual dx)

Maladie chronique non dégénérative

Question 2

What are the three types of SCIs?

Answer 2

SCI-C —> type constipation

SCI-D —> type diarrhée

SCI mixte —> alteration between and diarrhea

Question 3

What are the causes of SCI? (3)

Answer 3

1. Genetic and environmental factors
2. Trauma during childhood
3. SCI post-infectieux —> family hx, light sx that are exarcerbated by an infection and then turns into IBS

Question 4

What are the 2 main theories for the causes of IBS?

Answer 4

1. Théorie motrice:
   
   • Altération de la motricité digestive
   • Douleurs crampiformes, contractions de grande amplitude
   • 10-20% of pts
2. Théorie de l’hypersensibilité (50-90%)
   
   • Signal intestinal élevé, hypersensibillité à la distension
   • Amplification médullaire ou corticale
   • Non compensation par inhibition descendante

Question 5

What are the main things that are considered déclencheurs?

Answer 5

Eating/drinking, stress

Normal stimulus of the GI tract that are perceived in an exaggerated way

Question 6

How are SCIs diagnosed?

Answer 6

Pas un dx d’exclusion —> not only dx if it’s nothing else

• Histoire compatible
• Examen physique normal
• Examens biologiques normaux (si indiqué)

Question 7

What are the dx criteria for SCIs and most frequent sx?

Answer 7

Question 8

What are the most frequent comorbidities or SCIs? (3)

Answer 8

Digestive, somatic, and psychogenic comorbidities

Question 9

DDx of SCI:

Answer 9

Pain, constipation, and diarrhea

• Celiac disease —> serological test to check
• Maladies inflammatoires intestinales (MII)
• Infections entériques (ex: giardia)
• Néoplasie colique

Question 10

What are the important signes alarmes to know?

Answer 10

• Rectorragies
• Anemia, abdominal masses
• Weight loss
• Sx nocturnes
• Début récent des symptômes —> < 6 months
• Début à l’âge > 50 ans
• Histoire familiale de MII, néoplasie du côlon, mx coeliaque
• Sx obstructifs ou malabsorption

Question 11

How are SCIs treated?

Answer 11

VERY IMPORTANT TO REASSURE PTS AND PROVIDE THEM WITH INFORMATION

Pharmaco and physiotherapy only used if necessary

Question 12

Dietetic information for SCI tx:

Answer 12

Try diet w/o lactose, FODMAPS, consult with nutrition

Question 13

What are FODMAPS?

Answer 13

Question 14

General dietetic recommendations for SCI tx:

Answer 14

Question 15

Pharmacology information for SCI tx:

Answer 15

Tx pharmacologique if sx too intense or frequent

Identify and treat the principal sx

Question 16

VERY IMPORTANT MEDICATION NAMES… KNOW THEM!:

Answer 16

Question 17

Psychotherapy information for SCI tx:

Answer 17

Si psychopathologie associée

• Rôle du stress dans l’exacerbation des symptômes
• Importance de la reconnaissance du rôle du stress
• Journal alimentaire et du stress quotidien
• Hypnose, thx comportementale, counselling, thx interpersonnelle, meditation, yoga, etc.

Question 18

What is dyspepsie fonctionnelle?

Answer 18

recurring signs and symptoms of indigestion that have no obvious cause

Also called: dyspepsie non-ulcéreuse → similar pain as ulcers but without the actual ulcers

Douleur/inconfort: épigastrique chronique (plus de 3 mois), SANS anomalie organique → type ulcéreux ou type moteur

Physiopathology: visceral hypersensibility or lack of relaxation of the fundus (top of stomach —> can’t fill as much)

Question 19

What are some things that may help with dyspepsie fonctionnelle?

Answer 19

Bénéfice marginal de l’éradication de l’H. pylori

Gastroparesis rare without other risk factors

What is the #1 FDR?

• Type 1 or complicated diabetes

Question 20

How is df dx?

Answer 20

Dx based on clinical hx w/o chronic sx

Normal e/p and labs

No sx d’alarme

Question 21

How is df treated?

Answer 21

General: reduce stress, CONS w/ nutrition

Eradication H.pylori if present

Trial with IPP —> to dim. reflux

Increase fundic relaxation using diclycomicin

Visceral painkillers (amitryptilline)

CONS w/ psych if necessary

Question 22

What are the most common risk factors for gastroparesis (partial paralysis of the stomach)? (7)

Answer 22

1. Multicomplicated diabetes
2. Scleroderma
3. Pseudo-obstruction intestinal chronique
4. Post-vagotomie
5. Maladies neurologiques (Sclérose en plaques (MS), Parkinsons)
6. Chronic use of opioids or anticholinergics
7. Metabolic or ionic problems