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19 Cards in this Set
- Front
- Back
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IBS |
chronic episodic medical coniditon characterized by a group of symptoms
abdominal pain associated with constipations and or diarrhea, bloating and distention
functional bowel disorder
most common of 25 hgids |
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IBS history |
long dismissed as a psychosomatic condition
no clear etiology, affects predominantly women, no fatal
attitudes now changing
incidence and prevalnce no extensively monitored |
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Direct medical cost |
results in 8 billion annually
IBS sufferers incur 74% more direct healthcare costs than non-IBS sufferers
IBS patients have more physician visits for both GI and non-GI complaints |
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IBS impact on quality of life |
on average have health related issues during half the month |
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extent and impact of IBS |
high prevalence of disease in US population, annual cost is high, reduced quality of life, accts for 12% of primary care and 28% of gyn visits |
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IBS substypes |
recurrent abdominal discomfort or pain of at least 3 days per month in the last 3 months with 2 or more
improvement with defecation and/or onset associated with change in freq of stool, onset assocated with change in stool appearance or form |
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IBS clinical subgroups |
constipation C
diarrhea D
alternator |
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Stool consistency as a main determinant of subtype |
corrlates with colonic transit
increased Bristol stool form score with decreased colonic transit
corresponds with what patients and community samples think of as diarrhea, principle determinant of incontinence, other fetures occur in IBS with both loose and hard stools |
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Red flags |
unintended or unintentional weight loss
fever
overt occult blood in stool
frequent nocturnal bowel movement
anemia, family history of IBD, sudden onset after 50, colon cancer history |
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IBS overlap |
chronic constipation
celiac disease
IBD
endometriosis
chronic pelvic pain
chronic functional ab pain |
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Predisposing factors |
female gender, early life adversity/stressfull life events
family history; genetics and social learning influences
specific genes |
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Pathophy |
brain gut dysregulation
visceral sensitivity
abnormal motility |
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alterations in motility |
during meal, sigmoid motility increases markedly when compared to normal
helps to explain IBS but not sufficient to describe pain
measured abnormalities in GI motor function do no define IBS |
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enhanced visceral sens |
pain during distention and lower levels of pressure
visceral hypersensitivity is more pronounced, but not from outer stimuli |
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Brain-gut interplay |
modulating effect of CNS on ENS on abnormalities in motility and sensitivity
integrated circuits of feedback and reflexes allow for error to occur
shown how contractile state increases during "stress" |
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Irritable "Brain" Syndrome |
pain disproportionate to motility changes, absence of motility problems during sleep, psychiatric comorbidity
functional somatic symptoms whos pathophys involves aberrant central processing of sensory stimuli, efficacy of centrally acting agents
neuroimaging show abnormalitities in central pain processing
use psych drugs to treat |
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Cognitive behavior therapy |
way an individual thinks about an event not the event itself how he or she response
thoughts behaviors become learned but can be identified and unlearned through formal instruction
changes in behavior/cognitive activity affect index problem |
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Dx and mgmt |
establish a positive dx
reassure patient there is nothing seriously wrong
success of current treatment has been limited |
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Rx |
dicyclomine HCl
anticholinergics (smooth muslce relaxanats via anit M3 or direct action on smooth muscle)
belladonna and phenobarbital
Antidiarrheals = increase stool firmness and decrease frequency
laxatives and bulking agents = increased fiber osmotic laxatives and stimulant laxatives
SSRIs for pain
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