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.