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30 Cards in this Set

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Define irritable bowel syndrome (IBS)..otherwise known as spastic colon, mucous colon, nervous colon?
<most common digestive disorder diagnosed by gastroenterologists and one of the most common disorders seen by primary care physicians> ...

<affecting 10-20% of general population>...


chronic GI disorder, <characterized by presence of chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating...>

begin to appear in young
adulthood...
characterized by remissions
and exacerbations..
the exact cause of IBS is unknown..
<women (esp during menstruation) have IBS two to three times greater than men...>
<IT'S NOT A DISEASE...IT'S A FUNCTIONAL DISORDER!>

<the nerves and muscles in the bowel are extra-sensitive...the muscles may contract too much when eating..these contractions can cause cramping and diarrhea during or shortly after a meal...or nerves can be overly sensitive to the stretching of the bowel (because of gas, for example)...cramping or pain can result...IBS can be painful, but it does not damage the bowel or cause any other diseases>

<April is IBS Awareness Month>
What is IBS due to?
impairment in motor or sensory function of GI tract
IBS symptoms such as changes in normal elimination patterns are often associated with?
meals

<it is a continuous or recurrent lower abdominal pain or cramping from mild to excrutiating) in association with altered bowel motility (diarrhea, constipation, or both)>
Physical factors that may contribute to IBS are?
diverticular disease
lactose intolerance
coffee
other gastric stimulants
stress possibly
mental or behavioral illness
possibly
analgesics possibly
What is the Manning criteria?
the collective symptoms for IBS which include:
abdominal pain relieved by
defecation or associated
with changes in stool
frequency or consistency
abdominal distention
sensation of incomplete
evacuation of stool
presence of mucus with stool
passage
The most common symptom of IBS is pain in the?

after eating and relief after a bowel movement...nausea may accompany both
LLQ...then there is increased pain when?
What do the stools look like with IBS?
small and hard and are generally followed by several softer stools...may be soft and watery, and mucus is present in the stools...also complaints of belching, gas, anorexia, bloating
AUSCULTATION of abdomen finds that bowel sounds are generally within normal range and may be somewhat quiet with constipation.

okay
okay
On PALPATION, there may be diffuse tenderness, which is generally worsened if _______ _________ is palpable.
sigmoid colon
The following routine lab tests are usually normal with IBS?
CBC
serologic tests
serum albumin
ESR
stools for occult blood
What might be noted during a barium enema that would support the diagnose IBS?
colonic spasm
What does a colonoscopy show?
intense spastic contractions, which often stimulate painful sensations...otherwise, bowel mucosa appears continuous, smooth, and pink

(a sigmoidoscopy is run in adults younger than 40yo and a colonoscopy is run in adults older than 40yo)
<Attacks of IBS may strike when?>
<suddenly at any time of day or night, and may occasionally - though not typically wake you from a sound sleep>
<Which symptoms are NOT associated with IBS?>
<passing blood, running a fever, swollen extremities, and joint pain...these symptoms point to other disorders>
<What are the Rome II Guidelines?>
<presumes absence of structural or biochemical explanation for symptoms and is made only by physician

IBS can be diagnosed based on at least 12 weeks (which need not be consecutive) in the preceding 12 months, of abdominal discomfort or pain that has two out of three of these features:
1. relieved with defecation,
and/or
2. onset associated with
change in frequency of
stool; and/or
3. onset associated with
change in form
(appearance) of stool>
How can the nurse help the IBS patient with diet?

30 to 40 g daily and drink 8 to 10 cups of water per day...chew food slowly.
First of all, eliminate upsetting foods and <eliminate alcohol and caffeine, decaf coffee too, high-fat foods, insoluble fiber, carbonation...eliminate beverages containing sorbitol and fructose, and other gastric irritants...avoid milk and milk products if lactose intolerance suspected (use lactose-free or soy products instead)...so how many grams of fiber should be included every day?
What kind of meds might a doctor presribe for patients with IBS?

doctor may prescribe psyllium hydrophillic mucilloid (Metamucil) or calcium polycarbophil (Mitrolan) taken with water and help prevent dry, hard, or liquid stools

what if it's diarrhea-predominant IBS?
bulk-forming laxatives
anti-diarrheal agents
anticholinergic agents
tricyclic antidepressants
5-HT agonists

what if it's constipation-predominant IBS?

it's typically treated with antidiarrheal agents, such as diphenoxylate hydrochloride with atropine sulfate (Lomotil) or loperamide (Imodium)
What might the doctor prescribe if it's constipation-predominant IBS?
doctor may prescribe psyllium hydrophillic mucilloid (Metamucil or Karacil) or calcium polycarbophil (Mitrolan) taken with water and help prevent dry, hard, or liquid stools

(if patient reports excessive cramping, rectal bleeding, nausea, or vomiting, d/c the drug)
what if it's diarrhea-predominant IBS?
it's typically treated with antidiarrheal agents, such as diphenoxylate hydrochloride with atropine sulfate (Lomotil...teach patient to report abdominal distention, pain, and fever as these symptoms may indicate a bacterial organism in GI tract...diarrhea should NOT be suppressed in the presence of GI INFECTION!...also teach patient to report sedation, dry mouth, urinary retention, and rash as common side effects.

loperamide (Imodium)...
teach client to report abdominal distention, pain, and fever...these symptoms may indicate a bacterial organism in GI tract...diarrhea should NOT be suppressed if GI INFECTION present!
What might the doctor prescribe in which pain is the predominant symptom?

relief of abdominal cramping and intestinal spasm....also tricyclic antidepressants such as amitriptylin (Elavil) help with IBS...about how many minutes before mealtime should these meds be taken?
anticholinergics (blocks cholingergic or PNS)
antispasmodics
ex: dicyclomine hydro-
chloride (Bentyl)

and what do these meds achieve?

30 to 45 minutes
What are drugs given to women who have constipation as their primary symptom?

Zelnorm imitates the action of serotonin to stimulate peristalsis in the GI tract...usual dosage is 6 mg twice daily before meals for 4 to 6 weeks...take 30 minutes before meals because food decreases drug's absorption....and teach client to take extra birth control precautions, if appropriate because the drug decreases the effect of oral contraceptives....also teach client to report dizziness, irregular pulse, angina because the drug can cause CV side effects/adverse effects
5-HT4 meds
ex: selective partial
agonist tegaserod
(Zelnorm) or
prucalopride which
possesses GI prokinetic
activity

and what is Zelnorm's MOA?
<What are supportive symptoms of IBS?>
<fewer than three bowel
movements per week
more than 3 bowel movements
per day
hard or lumpy stools
loose (mushy) or watery
stools
straining during a bowel
movement
urgency (having to rush to
have a bowel movement)
feeling of incomplete bowel
movement
passing mucus (white
material) during a bowel
movement
abdominal fullness, bloating,
or swelling>
<What are the red flag symptoms which are NOT typical of IBS?>
<pain that often awakens/interferes with sleep...
diarrhea that often awakens/interferes with sleep...
blood in stool (visible or occult)...
weight loss
fever
abnormal physical examination>

<there is no cure for IBS, just management and prevention>
<The fundamental idea for IBS is to avoid foods that trigger or irritate spastic ______ via the ______ ________ that occurs when food enters the stomach and to eat foods that soothe and regulate the colon. This will relieve both ________ and _______as well as painful spasms and cramps, gas, nausea, and bloating of IBS.>
<colon
gastrocolic reflex

constipation
diarrhea>
<What is the single greatest digestive tract stimulant?>
<FAT>
<When food enters the stomach, it triggers which reflex?>

<colon starts to contract...and that's why an IBS attack occurs within minutes of eating even though food is nowhere near the colon>
<gastrocolic>

<and what does that cue?>
<Other foods to avoid?>
<RED MEAT
ex: ground meat
hot dogs
steaks
roast beef
pastrami
salami
bologna
sausage
pork chops
poultry dark meat/skin
dairy products
whey and casein which
are proteins that
cause indigestion
egg yolks>

<(try to go organic)>
<Other foods to avoid?>
<all fried foods
tartar sauce
margarine
cool whip
coconut milk
olives
pie crust
biscuits
solid chocolate
shredded coconut>
<IBS is not life-threatening, nor progressive...it's just a distressing nuisance and is the second highest cause of absenteeism after the common cold.>

<Of the theories out there, it seems clear that IBS is related to?>
<stress
underlying emotional
disorders
3 times more common in
women than men>
Complementary and Alternative Therapies to reduce symptoms and discomfort of IBS include?
peppermint and caraway oil
combination
evening primrose oil
chamomile
yoga and other relaxation
techniques
hypnosis
acupuncture