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)