Irritable Bowel Syndrome

Celiac Disease EGD

_______: Inflammatory disorder characterized by malabsorption precipitated by *gluten*; *genetic disorder* common in US and Europe Features: -Diarrhea (tan/gray, frothy, foul), flatulence, wt loss, abdominal distension, *failure to thrive in children* - Use what?

Irritable bowel syndrome

________: Functional GI disorder characterized by abdominal pain/discomfort and altered bowel habits in the absence of specific organic pathology Usually a diagnosis of EXCLUSION - a "clinically defined illness" *CHRONIC, RELAPSING CONDITION* issues for several months Does NOT increase mortality More common in females and usually less than 35 years old

Crohn's Disease

________: can involve *ANY part of GI tract*, inflammation extends through intestinal wall from mucosa to serosa (small bowel, colon common) Features: -Onset 15-35 and 70-80 years -Fever, abdominal pain, diarrhea (often without blood), wt loss common -Anorectal fissures and abscesses common -*Colonoscopy* - nodularity, rigidity, ulcers, strictures, fistulas

colon cancer left sided

________: common malignancy, one of more potentially curable Features: -Most common in patients > 50 years old -_________ sided: rectal bleeding, change in bowel habits, abdominal or back pain Cecal or ascending colon: anemia, occult blood in stool, wt loss Colonoscopy

Diverticulitis LLQ

_________: Diverticula (pockets/hernias) of colonic mucosa through muscularis become occluded and inflamed Features: -Pain (esp. ______), fever, change in bowel habits, leukocytosis common -CT scan, BE, colonoscopy

Constipation Diarrhea

__________ = "hard stools", painful or infrequent defecation , straining <3 stools/week _________= small volumes of loose stool, usually urgency with frequency, clear or white mucus in stool >3 stools/day Postprandial urgency common

Infectious Diarrhea

___________: chronic diarrhea with cramps Features: -Blood and mucus can be present in stool -Malaise and weight loss common -Recent travel risk factor -*Stool cultures*

Ulcerative colitis

____________: Inflammatory disease of mucosa and submucosa of the colon. End of GI - look up Features: -Peak onset 15-35 years -Bloody diarrhea with mucus, fever, abdominal pain, wt loss, and tenesmus common. *when they have bowel movement, no relief of symptoms* Colonoscopy - mucosal erythema, ulcers Barium enema - loss of haustration, mucosal irregularity, ulceration

Tricyclic Antidepressants: Imipramine (Tofranil) Amitriptyline (Elavil)

_____________ Visceral analgesic effect by increasing pain threshold in the gut, prolonging oral-cecal transit time Types: Predominant symptoms-pain and bloating, more often used in *IBS-D* 1. ___________ decreases abdominal pain, decreases mucorrhea, decrease stool frequency 2. ___________ same

Lactose Intolerance Hydrogen

______________ = Features: -Abdominal distension and bloating -Diarrhea and occasionally constipation usual presenting symptoms -*Symptoms exacerbated by the intake of dairy products* -Use ________ breath test

1. SSRIs, 2. Thyroid replacement, 3. antibiotics 1. Ca+ channel blockers

Abuse of laxatives causes bloating and chronic diarrhea Diarrhea secondary to medications: 1. 2. 3. Constipation secondary to medications: 1.

Diphenoxylate HCl with atropine sulfate (Lomotil) Loperamide (Immodium)

Antidiarrheals: non-absorbable synthetic opioids; prolong transit time and decrease secretion via peripheral opioid receptors Types of Antidiarrheals: 1. ______________inhibits excessive GI propulsion and motility (may exacerbate constipation) 2. _______________ improves stool frequency and consistency, decreases abdominal pain and fecal urgency

IBS-C IBS-D

*Altered GI Motility:* -Small bowel dysmotility -delayed meal transit in _______ -accelerated meal transit in _______ -Generalized smooth muscle hyperresponsiveness

3 3

*Patients must have recurrent abdominal pain or discomfort for at least ______ days per month during the previous ______ months that is associated with 2 or more of the following:* -Pain/discomfort relieved with defecation -Onset assoc with change in stool frequency -Onset assoc with change in stool form or appearance

1. Diarrhea dominant (IBS-D) 2. Constipation dominant (IBS-C) 3. Mixed diarrhea and constipation

Bowel patterns found in IBS: 1. 2. 3.

Methylcellulose (Citrucel) Psyllium

Bulk Forming Laxatives: -fiber supplementation to improve symptoms of constipation and diarrhea __________ =promotes bowel evacuation - forms viscous liquid, promotes peristalsis __________ Can increase gas and distention

Miralax Lubiprostone (Amitiza) Linaclotide (Linzess)

For IBS-C: ________ - osmotic laxative ___________ - increases colonic secretions ____________ - works in colon to increase bowel movements

Anticholinergics Dicyclomine HCl (Bentyl) Hycosamine Sulfate (Levsin)

IBS medications: _____________: antispasmodics that inhibit intestinal smooth muscle depolarization at the muscarinic receptor Types of Anticholinergics: ___________: decreases fecal urgency and pain useful for *DIARRHEA prominant* __________________ = Same Side Effects: urinary retention, constipation, tachycardia, and dry mouth

LLQ/RLQ

Irritable bowel syndrome: Abdominal pain: -Usually diffuse or __________ Intermittent, cramping Acute episodes of sharp pain with underlying dull ache Pain often relieved by defecation Abdominal distension: patients state they are "bloated" and have gas *Usually feel better (improve) after they have bowel movement *

1. Altered GI motility 2. Visceral Hypersensitivity 3. Psychopathology

Pathophysiology of IBS: 1. 2. 3.