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27 Cards in this Set
- Front
- Back
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What are the two names that actually matter regarding IBS?
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1. IBS for lower GI
2. Functional Dyspepsia for upper GI |
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What is the definition of IBS?
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-abd discomfort a/w altered bowel habits
-Diarrhea predominant -Constipation predominant -Mixed |
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What are the demographics of IBS?
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-10-20% of pop qualify, 1/2 get help
-2:1 F:M and mostly young pts -Expensive HC problem $30 billion/yr -BIG negative impact on quality of life |
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What are some common sx of IBS?
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-sense of STRAINING during a BM, mucus, bloating, feeling lik pt still has to "go more" after having a BM (sense of imcomplete evacuation)
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***What is the ROME III Criteria for IBS?
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1. Recurrent abd pain/discomfort (3 days/month for past 3 months) WITH 2 OR MORE OF THE FOLLOWING
-improvement w/ defecation -pain w/ change in bowel frequency -pain w/ change in bowel form |
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Pt cannot have any ALARM symptoms, what are ALARM symptoms?
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-Fever
-wt loss -bleeding, anemia or High WBC -abd mass -abnL rectal exam -Family hx of colon cancer - older than 50 |
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When ECL Cells detect a bolus what happens?
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-they release serotonin that causes increase upstream contraction, downstream relaxation (peristalsis)
-dont usually feel this b/c everything is smooth -in IBS there is altered serotonin signaling--> visceral hypersensitivity which leads to altered perception (like FM) |
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Where is serotonin found in the body, and what % is found in each location?
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-95% is in the gut
-only 5% in brain -therefore the drugs we use for brain/neuro problems can be used for problems in gut |
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What is the Bristol stool form scale?
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-it correlates stool form w/ intestinal transit time
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Best description of shit I've heard in medicine: Type 4 stool
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-like a sausage or snake, smooth and soft
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What are causes of IBS?
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-acute infective enteritis (minority may develop IBS)
-autoimmune -food allergy -STRESS DOES NOT cause IBS, but a hx of childhood sexual abuse is found in a sig proportion of adult IBS pts |
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***What labs need to be ordered in order to r/o Sprue (Celiac disease)?
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1. Abs: Anti-tissue transglutaminase (anti-tTg)
2. Total IgA level |
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When you are considering bacterial overgrowth bc it mimics IBS, what should you tx w/?
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-Rifaximin (non-absorbable abx) used for traveler's diarrhea and hepatic encephalopathy
-very expensive -can also use neomycin, augmentin x 10 days -evaluate after 1 month |
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Management of IBS for all pts
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-TONS of reassurance
-consider using the following: 1. Trazadone-Amitriptyline, Imipramine low does at bedtime 2. SSRIs - Escitalopram (b/c of serotonin abnormalities in IBS |
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Dietary changes in pts w/ diarrhea dominant IBS (IBS-D)
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-avoid caffeine
-avoid fatty/fried foods -gums/drinks w/ sorbitol and manitol -avoid lactose |
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Constipation dominant IBS (IBS-C) management
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-dietary changes (higher fiber: may worsen bloating; more fluids for old)
-stool softeners and anticholinergics have poor evidence -normalize GI motility -SIT on toilet and get comfortable taking a shit, goal of therapy is SCBM (spontaneous complete BM) |
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What is Lubiprostone?
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-stimulates type 2 Cl- channels, inc water secretion into the intestine
-it's like an enema from above and is very effective for M/F, young/old -good for IBS-C |
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***Functional Dyspepsia (FD)
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-IBS of the upper GI tract
-same hypersenitivity and motility problems but have to consider alternatives like pancreatic disease and GERD -no definitive dx test for FD so pts often frustrated |
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***Symptoms of FD:
Rome III criteria |
-epigastric pain/discomfort/burning
-postprandial fullness (unpleasant sensation of prolonged persistence of food in stomach) -Early satiation -Bloating -n/v and wt loss ***nL BMs*** -***need for at least 3 months |
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What are the 2 major dyspeptic syndromes?
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1. Postprandial distress syndrome (early satiation, postprandial fullness, meal related dyspepsia)
2. Epigastric pain syndrome (epigastric pain or burning) (not related to defecation or biliary tract) |
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Prevalence of Dyspepsia
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-20-30% of the population has dyspepsia
-consistent around the world -a very small minority have organic basis for the symptoms |
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Possible etiologies of FD
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1. Infx (H. pylori)
2. Diet (fat, nicotine, caffeine) 3. AbnL gastric acid secretion (gastrin releasing peptide) 4. GI motility disorder 5. AbnL GI hormones (CCK, gastrin, somatostatin) |
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Evaluation of FD
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-r/o cancer, GERD
-Endoscopy (def if >45 y/o w/ wt loss, bleeding, anemia) -Labs - CBC Amylase/Lipase (pancreatic), anti-tTG (Celiac), TSH |
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Tx of FD
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-reassure pt
-dietary changes (no caffeine, smoking, ETOH, fatty foods, NSAIDs) |
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***Why should you try an empiric trial of a PPI for a pt w/ suspected FD?
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-practically indistinguishable NUD from GERD (up to 43% of NUD have been found to have erosive esophagus on EGD
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Why should you consider the possibility of H. pylori?
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-b/c its a/w NUD
-Urea breath test can diagnose -treat w/ Prevpac (ABO + PPI) -use SSRIs, tri-cyclic antidepressants |
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***What are H. pylori eradication?
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-3-in-1 + PPI: bismuth subcitrate K, metronidazale, tetracycline regimen (BMT + PPI)
-Amoxillin + Clarithromycin + PPI |
