wk 4 6 IBS

Question 1

signs of IBS

Answer 1

chronic relapsing problem
ab pain
bloating
change in bowel habit

Question 2

3 factors causing IBS

key feature of IBS

Answer 2

genes
environment
disturbed GI motility (high-amplitude propagating contractions, exaggerated gastro-colic reflex, pain)
visceral hypersensitivity

Question 3

visceral hypersensitivity is seen in 2/3 patients, it involes a peripheral and central sensitisation, outline each

Answer 3

peripheral - inflam mediators up-regulate sensitivity of nociceptor terminals

central - incr sensitivity of spinal neurones

Question 4

define visceral hypersensitivity

Answer 4

intense pain felt in inner organs

Question 5

how would there be evidence of central hypersensitivity

Answer 5

spinal neurones affected - increased pain radiation to somatic structures (fibromyalgia)

Question 6

rome III criteria is used in diagnosing IBS, what does it specify

Answer 6

recurrent abdo pain/discomfort for at least 3 days per month, foor 3 months

2 or more of:
improvement with defecation
onset associated with change in stool frequency
onset associated withchange in stool appearance

Question 7

what are the additional clues of IBS 6

Answer 7

bloating 
urgency 
rectal tenesmus (unfinished) 
mucus per rectum 
nocturia + poor sleep
stress aggravates

Question 8

key things to look for in history

Answer 8

bowel habit
bloating, nocturia
diet - bread,fibre,meal times, bizarre exclusions
triggers - infection, menstruation, drugs
opiates
stress
underlying fears - cancer

Question 9

associated alarm features of IBS 9

Answer 9

age>>50
short duration of symptoms 
woken from sleep by altered bowel habit 
rectal bleeding 
weight loss 
anaemia 
FH oof colorectal cancer
recent antibiotics

Question 10

relevant investigations of IBS

Answer 10

FBC 
CRP count 
anti-TTG (coeliac) 
ESR (inflam blood test) 
lower GI tests if >50/ strong fam history of colorectal cancer

Question 11

treatment for IBS

Answer 11

diet - regular meal times, reduce fibre

drugs - stop opiate analgesia
anti-diarrhoeals/spasmodics/depressants

Question 12

dietary advice for IBS

Answer 12

restrict tea and coffee
reduce intake of ‘resistant starch’
if diarrhoea - avoid sorbitol

if persistant - exclusion diets

Question 13

prolonged use of opiates can lead to opiate/narcotic bowel syndrome, highlight the characteristics of this

Answer 13

worsening pain control despite incr in dose
reliance
progression of frequency,duration,intensity of pain
no GI explanation for pain

Question 14

t/f fibre can aggravate pain

Answer 14

true

Question 15

how does anti-diarrhoeals work

Answer 15

inhibit peristalsis and gut secretions

Question 16

give an example of an anti-diarrhoeals

Answer 16

loperamide (tablet/syrup)

Question 17

t/f loperamide has no effect on pain

Answer 17

true

Question 18

explain how anti-depressants (tricyclis - amitriptyline) aid in IBS

Answer 18

reduce diarrhoea - reduces afferent signals from gut (central analgesics_
helps restore sleep pattern

Question 19

if no response to empiric anti-depressents, what would be considered

Answer 19

relaxation therapy
cognitive behavioural therapy
hypnosis

Question 20

peripheral hypersensitivity involves the noicioceptors producing lots of neuropeptides. What causes this and Explain this effect

Answer 20

peripheral sensitisation - incr sensitivity to an afferent nerve stimuli
occurs after cell damage to an area, causes an increased sensitivity to heat/touch which is interpreted as pain

Question 21

central hypersensitivity

Answer 21

chronic pain

lowers threshold for what causes pain, maintains pain after injury/infammation