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19 Cards in this Set

  • Front
  • Back


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

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

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

IBS impact on quality of life

on average have health related issues during half the month

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

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

IBS clinical subgroups

constipation C

diarrhea D


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

Red flags

unintended or unintentional weight loss


overt occult blood in stool

frequent nocturnal bowel movement

anemia, family history of IBD, sudden onset after 50, colon cancer history

IBS overlap

chronic constipation

celiac disease



chronic pelvic pain

chronic functional ab pain

Predisposing factors

female gender, early life adversity/stressfull life events

family history; genetics and social learning influences

specific genes


brain gut dysregulation

visceral sensitivity

abnormal motility

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

enhanced visceral sens

pain during distention and lower levels of pressure

visceral hypersensitivity is more pronounced, but not from outer stimuli

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"

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

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

Dx and mgmt

establish a positive dx

reassure patient there is nothing seriously wrong

success of current treatment has been limited


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