IBS Flashcards

1
Q

define IBS

A
A functional bowel disorder defined as recurrent episodes of abdominal pain/discomfort (in the absence of detectable organic pathology) for > 6 months of the previous year, associated with two of the following: 
o	Altered stool passage  
o	Abdominal bloating  
o	Symptoms made worse by eating  
o	Passage of mucous
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2
Q

what are the risk factors of IBS?

A

-visceral sensory abnormalities
- gut motility abnormalities
- psychosocial factors
- food intolerance
-

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3
Q

epidemiology of IBS?

A
  • common

- more common in females

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4
Q

presenting symptoms of IBS?

A
  • abdominal pain
  • Altered bowel frequency
  • abdominal bloating
  • change in stool consistency
  • passage with urgency
  • tenesmus
  • faecal urgency
  • Feeling of incomplete stool evacuation
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5
Q

what are the red flags symptoms?

A
o	Weight loss  
o	Anaemia  
o	PR bleeding  
o	Late onset (> 60 yrs)  
o	Family history of bowel or ovarian cancer 
- must exclude colonic malignancy
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6
Q

what are the signs of IBS on physical examination?

A
  • Usually NORMAL on examination

* Sometimes the abdomen may appear distended and be mildly tender on palpation in one or both iliac fossae

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7
Q

what bloods should be done?

A
  • FBC (anaemia)
  • LFT
  • ESR, CRP
  • TFT
  • anti-endomysial/anti-tranglutaminase antibodies (coeliac disease)
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8
Q

what other examinations should be done for IBS?

A
  • Stool examination: microscopy and culture for infective cause
  • Ultrasound: exclude gallstone disease
  • Urease breath test: exclude dyspepsia due to Helicobacter pylori
  • Endoscopy: if other pathologies suspected
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9
Q

what general diet advice should be given for IBS?

A
o	Have regular meals and take time to eat 
o	Avoid missing meals 
o	Drink 8 cups of fluid a day 
o	Restrict tea and coffee 
o	Reduce alcohol and fizzy drinks 
o	Reduce resistant starch intake in processed foods 
o	Limit fresh fruit 
o	Increase oat intake
o	Limit high fibre foods
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10
Q

first line pharmaceutical treatment for IBS?

A

o Pain: antispasmodic agents
o Constipation: laxatives (not lactulose)
o Second-line for constipation post 12 months is linaclotide (cLOT)
o Diarrhoea: loperamide (sLOP)

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11
Q

what is second line pharmaceutical treatment for IBS?

A

o Low dose tricyclic antidepressants (5-10)

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12
Q

what are the complications of IBS?

A
  • Physical and psychological morbidity

* Increased incidence of colonic diverticulosis

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13
Q

what is the prognosis for patients with IBS?

A
  • Chronic relapsing and remitting course of the disease

* Often exacerbated by psychosocial stresses

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