Irritable Bowel Syndrome
What is a Hospital anxiety and depression scale?
14 item questionnaire
What is a patient health questionnaire?
15 item questionnaire Identifies multiple somatic symptoms
How is IBS distinguished from IBD : What symptoms occur in both?
Abdominal pain Diarrhoea (rarely nocturnal in IBS) Bloating
What is Carrnett's test for abdominal wall?
Abdominal pain remains unchanged is the abdominal muscles of the wall are tensed e.g. ask to raise just head and shoulders off bed without using hands
What are the "alarm" features?
Age >50 Short history of symptoms Documented weight loss Nocturnal symptoms Male Family history of colon cancer Anaemia Rectal bleeding Recent antibiotic usage
What is the extra list of symptoms?
Altered stool passage Abdominal bloating Symptoms made worse by eating Passage of mucus
When should a patient be refered to secondary care w.r.t. examination?
Anaemia Abdominal masses Rectal masses
What is loperamide?
Anti-diarrhoeal
What are hyoscine and mebeverine?
Anti-spasmodics
What medication can be given to treat the pain associated with IBS?
Antispasmodics Tricyclic antidepressants
What are the clinical features of IBS?
Bloating Abnormal stool form / frequency Straining at defecation Urgency Feeling of incomplete evacuation Mucus per rectum Aggravated by stress
What is the best way to identify an IBS patient?
Chronic, relapsing GI problem characterised by: - abdominal pain - bloating - changes in bowel habit
Why does nocturnal diarrhoea occur?
Colonic motility is much reduced at night
What are the three classifications of IBS?
Diarrhoea predominant (IBS-D) Constipation predominant (IBS-C) Mixed (IBS-M)
Is IBS more common in males or females?
Females
What are the commonly reported food intolerances?
Fibre Lactose Wheat (yeast) (fat)
Describe bloating in IBS
Frequent and obtrusive
What investigations should be done to confirm the diagnosis? (lab)
Full blood count ESR C-reactive protein Antibody testing for coeliac Faecal calprotectin
What investigations should be done to confirm the diagnosis? (psychological)
Hospital anxiety and depression scale Pateint health questionnaire
What does nocturnal diarrhoea suggest?
IBD Bile salt malabsorption Diabetic diarrhoea Small bowel bacterial overgrowth
How is IBS distinguished from IBD : What are the different non-GI symptoms?
IBS --> headache, backache IBD --> polyarthragia, skin lesions
Which type of IBS should eat breakfast?
IBS-C
Which type of IBS should consider yoghurt?
IBS-D
What other advice is given to IBS patients?
Identify triggers (stress?) Eat breakfast Eat kiwis Consider yoghurt consider milk withdrawal Eat regular meals Limit alcohol
When does bloating occur in IBD?
If obstruction
What is the nice criteria for diagnosing IBS?
If person reports having had any of ABC for at least six months: Abdominal pain or discomfort Bloating Change in bowel habit
When should a pelvic exam be considered?
If significant concern that symptoms may suggest ovarian cancer
What effect do dietary FODMAPS have?
Increase production of gas (hydrogen) thus increasing bloating
What food type should be discouraged?
Insoluble fibre e.g. bran
What is isphagula?
Laxitive
What are the non-gastrointestinal features of IBS?
Lethargy Back ache Headache Dyspareunia Urinary symptoms
How is IBS distinguished from IBD : What non-GI symptoms occur in both?
Lethargy Malaise Anxiety Depression
What is the optimum management?
Lifestyle Dietary modifications Psychological Pharmacological
What is ESR (erythrocyte sedimentation rate)
Non-specific measure of inflammation
How is the diagnosis made in practice w.r.t history?
Pain Bowel habit Psychological features Family history Diet Exacerbating factors
What is dyspareunia?
Painful sexual intercourse
How is the abdominal pain / discomfort in IBS further described by NICE guidelines?
Relieved by defecation or associated with altered bowel freqyency and stool form and two from extra list of symptoms
What is an altered stool passage?
Straining, urgency, incomplete evacuation
What is faecal calprotectin test?
Test for intestinal inflammation
What is amitriptyline?
Tricyclic antidepressant
When should a patient be refered to secondary care w.r.t. history?
Unexplained weight loss New diarrhoea Rectal bleeding Bowel or ovarian cancer Stools are looser if age > 60 or if duration >6 weeks
How is the diagnosis made in practice w.r.t. examination?
Visceral pain is poorly localised Carnett's test for abdominal wall Perianal and rectal exam (should be normal in IBS)