Week 1 Flashcards
Describe relationship between gut flora and IBS.
- Alterations in the intestinal biome
- Small bowel bacterial overgrowth
- The fecal microflora also differs among patients with irritable bowel syndrome versus controls
Altered GI motility
includes distinct aberrations in small and large bowel motility.
- Colonic dysmotility in irritable bowel syndrome manifests as variations in slow-wave frequency and a blunted, late-peaking, postprandial response of spike potentials.
- Small bowel dysmotility manifests in delayed meal transit in patients prone to constipation and in accelerated meal transit in patients prone to diarrhea.
Visceral hyperalgesia
- Enhanced perception of normal motility and visceral pain characterizes irritable bowel syndrome.
- hypersensitivity appears with rapid but not with gradual distention.
- Patients describe widened dermatomal distributions of referred pain.
Distinguish between IBS-C, IBS-D, and IBS-mixed.
- IBS-D (diarrhea predominant)
- IBS-C (constipation predominant)
- IBS-M (mixed diarrhea and constipation)
Explain changes induced in central nervous system by stress response that are mediated by neurohormones such as serotonin
- imbic system mediation of emotion and autonomic response enhances bowel motility and reduces gastric motility to a greater degree in patients who are affected
Correlate the OSE findings to the patients clinical presentatio
○ Decreased lumbar lordosis: most likely due to the chronic hypertonicity of the lower thoracic and lumbar region
○ Increased paraspinal muscle hypertonicity in the lower thoracic and lumbar regions: The nerves that innervate the small and large intestines reside in the lower thoracic and lumbar region. The hypertonicity is caused by a vicerosomatic reflex
○ Multiple discrete, tender, mobile, tapioca-like nodules in the subcutaneous tissue along the upper 2/3 of anterolateral femur: Chapmans points for the colon are on the anterior-lateral side 2/3 of the femur. Since the colon is affected with IBS then it make sense that irritation caused from IBS causes the chapman’s points.
- Abdominal mesenteries have motion restrictions
treatment plan including the use of OMT for patient with irritable bowel syndrome
- IBS with constipation: Patient would be advised to start FODMAPS diet, advised to try elimination diet and keep a food diary to try and pinpoint specific foods; increase water intake, and started on soluble fiber supplement or to try stool softener or a laxative, also be encouraged to increase their exercise to help with motility. Patient would be instructed to try OTC probiotic or prescribed one. If patient is dealing with high stress/emotional trauma then physician may suggest coping mechanisms or advise the patient to start seeing counselor. Patient may also be prescribed SSRI to help control symptoms.
- IBS with diarrhea: Patient would have same plan as above but instead of starting fiber/stool softener/ laxative they would be started on anti-diarrheal (such as immodium) to decrease their diarrhea.
optimal dietary and hydration habits for the prevention and control of constipation
- The best diet to help with constipation is to increase fiber intake. ( broccoli, beans, avocado)
- Dehydration has been identified as a potential risk factor for constipation.
rationale for pro-biotic supplementation in the management of constipation
-gut microbiota in patients who suffer from constipation differ from the gut microbiota of normal patients. The use of probiotics would help to replace the normal gut microbiota in patients who suffer from constipation so that they can start having more frequent bowel movements. Normalizing gut microbes would also help in break down and absorbance of nutrition from foods we eat.
diagnostic evaluation and pharmacologic management of functional bowel disorders
- diagnosed based on clinical history with normal PE and absence of alarm features
- Rome IV criteria can also be used: Recurrent abdominal pain at least 1 day a week for past 3 months w/ change in frequency of bowel movement OR change in stool/defecation; Symptom onset is usually 6 months before diagnosis
role for diagnostic testing in the evaluation of patients with suspected IBS
- Diagnostic testing is not routinely indicated because findings are normal in irritable bowel syndrome; however, limited evaluation is recommended in certain scenarios:
- Check tissue transglutaminase and endomysial antibodies to exclude celiac disease in patients with diarrhea-predominant and mixed irritable bowel syndrome
- Consider CBC to exclude anemia in older patients presenting for the first time
- Consider checking serum inflammatory markers to exclude inflammatory bowel disease in diarrhea-predominant cases
MOA and indications of Polyethylene glycol 3350
An osmotic agent, polyethylene glycol 3350 causes water retention in the stool; increases stool frequency
MOA and indications of Bisacodyl
Stimulates peristalsis by directly irritating the smooth muscle of the intestine, possibly the colonic intramural plexus; alters water and electrolyte secretion producing net intestinal fluid accumulation and laxation
MOA and indications of Psyllium
soluble fiber. It absorbs water in the intestine to form a viscous liquid which promotes peristalsis and reduces transit time.
STW5
reduce gastrointestinal hypersensitivity and show spasmolytic activities on spastic, but tonicizing on atonic gastrointestinal muscles. In addition, a stimulating effect on reduced mucus secretion, an inhibitory effect on enhanced gastric acid secretion and anti-inflammatory effects have been shown
