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GI > Irritable Bowel Syndome > Flashcards

Irritable Bowel Syndome Flashcards

1
Q

Most common functional bowel disorder

A

Irritable bowel syndrome

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2
Q

What is IBS

A

Functional bowel disorder in which abdominal pain is associated with defecation or change in bowel habits

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3
Q

Risk factors for IBS

A

Young female from an affluent family, recent antibiotic use, depression, bacterial gastroentritis (Camphylobacter)

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4
Q

Can IBS be diagnosed as hypochondriasis

A

Yes, hypochondriasis is also known as illness anxiety disorder (IAD) which is people diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having mild or no symptoms

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5
Q

How can IBS be classified

A

Using ROME III classification based on stool consistency

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6
Q

What is IBS-C classification

A

IBS with constipation

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7
Q

What is IBS-D classification

A

IBS with diarrhoea

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8
Q

What is IBS-M classification

A

IBS with mixed bouts of diarrhoea and constipation

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9
Q

What is IBS-U classification

A

IBS unsubtyped

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10
Q

Pathophysiology of IBS

A

Abnormal motility, either delayed in IBS-C or accelerated in IBS-D
Visceral hypersensitivity with abnormal sensitization within dorsal horns of CNS due to dysregulation within brain-gut axis

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11
Q

What chemical plays an important role in IBS

A

Serotonin (5-HT), this is involved in bidirectional communication along brain-gut axis

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12
Q

Cause of IBS

A

Local inflammation, abnormal colonic flora and bacterial overgrowth, abnormal gas propulsion, food intolerance, genetics

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13
Q

Symptoms of IBS

A

Lower abdominal pain/discomfort, altered bowel function - urgency, consistency, frequency, bloating

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14
Q

How does ROME 3 identify IBS

A

Abdominal pain atleast 3 days per month per last 3 months/12 weeks with >= 2 of the following -
Improvement with defecation
Onset association with change in stool frequency
Onset associated with change in stool form

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15
Q

Treatment of IBS

A

Education, support, diet (high fibre, 20-30g/day), medial management, physical activity, fluid intake, psychological or behavioral options

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16
Q

Medical mangement of IBS

A

Antispasmodic drugs - Alverine citrate, mebeverine hydrochloride, peppermint oil
Laxative for IBS-C
Anti-motility drugs - Loperamide hydrochloride
2nd line - Low dose tricyclic antidepressant for abdominal pain or discomfort. 5-HT reuptake inhibitor if this doesn’t work

17
Q

What can be offered to patients without relief of IBS after 12 months of treatment

A

Psychological intervention

18
Q

What laxative should be avoided in IBS treatment

A

Lactulose as it causes bloating, might worsen abdominal pain

19
Q

What can be used in IBS-D

A

Loperamide (anti-diarrhoeal). Decreases frequency of bowel movement, improves stool consistency and doesn’t affect abdominal pain or distention

20
Q

What kind of psychological treatment is available for IBS patients

A

Psychotherapy, hypnotherapy and cognitive behaviour therapy (CBT)

21
Q

Ileostomy vs Colostomy stomal appearance

A

Ileostomy - Tulip flower appearance, narrow

Colostomy - Wider opening

22
Q

Indications for elective surgery

A 
Medically unresponsive disease
Intolerability
Dysplasia/metaplasia
Growth retardation in children
Attempted resolution of extra-intestinal disease
23
Q

How can the severity of ulcerative colitis be assessed

A

Using Truelove and Witt criteria

Classified as mild, moderate or severe

24
Q

Parameters of Truelove and WItt criteria

A 
Number of bowel movement per 34 hours
Blood in stool (haematochezia)
Pyrexia
Heart rate > 90
Anaemia
Erythrocyte sedimentation rate > 30
25
Q

What are nervi erigentes

A

Pelvic splanchnic nerves that arise from sacral spinal nerves S2, S3 and S4

26
Q

When should colonoscopy be done post IBD diagnosis

A

10 years

27
Q

Surgery for duodenal or pyloric stenosis

A

Gastrojejunostomy - Anastomoses between stomach and proximal loop of jejunum

28
Q

Surgery for stricture/lesion formations

A

Balloon dilation or stricturoplasty

29
Q

Mangement of fistula

A

SNAP -
Sepsis - Drain abscess, remove cause, avoid antibiotics, skin protection
Nutrition - Restrict/control fluid intake, parenteral/distal end nutrition
Anatomy - Fistulography, CT/MRI, bowel enema
Plan/Procedure

30
Q

Anal fistula treatment

A

Control rather than cure
Seton; surgical grade cord through the fistula tract is popular option.
Drainage seton - Tied loosely to allow fistula to drain while its healing
Cutting seton - Tied tight around sphincter allowing it to slowly cut through tissue inside the loop while scarring behind, essentially pulling out the fistula

31
Q

Can Crohns be cured by surgery

A

No, can manage symptoms

GI (32 decks)

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