IBS vs IBD: Key Differences and Diagnosis

Irritable Bowel Syndrome (IBS)

• This is a disorder characterized by abnormal bowel motility
• Unlike inflammatory bowel disease (IBD), there is no damage to the intestinal lining or increased risk of colon cancer
• IBS is a "functional" disorder, meaning it involves impairment of the body's normal function without structural involvement
• Affects about 15% of the population, and women are slightly more at risk
• It usually begins in mid-20s, with most cases starting before 35 years old
• People with anxiety and/or depression are more likely to be affected by IBS, suggesting a link between the gut and the brain (gut-brain axis)
• Has an unknown mechanism
• It may involve visceral hypersensitivity to various stimuli, such as certain foods and emotional stress
• Risk factors include previous gastroenteritis or food poisoning, stress, anxiety, and depression
• Triggers are variable and inconsistent, but may include diet, eating too quickly or irregularly, drugs, and hormones
• Signs and symptoms include:
• Colicky, lower abdominal pain that is relieved with defecation
• Change in frequency and consistency of bowel movements, like constipation (IBS-C), diarrhea (IBS-D), or both (IBS-M, mixed)
• Bloating and distension of the abdomen
• Sensation of incomplete emptying after bowel movements
• Mucus in stool
• Systemic symptoms: nausea, headaches, fatigue, anxiety, depression, and difficulty concentrating
• The Bristol Stool Chart is a medical aid designed to classify stools
• Types 1 and 2 indicate constipation
• Types 3 and 4 considered normal
• Type 5 may or may not be normal
• Types 6 and 7 indicate diarrhea
• Diagnosis is symptom-based and can involve blood tests, stool samples, and colonoscopy to rule out more serious conditions (IBD, ulcers, or cancer)
• PE is usually WNL except for potential tenderness w/ colon palpation.
• Indications for Referral:
• Consistent rectal bleeding
• Weight loss
• Unexplained IDA
• Family medical history of colorectal CA
• Treatment varies depending on triggers and presentation
• Identify and eliminate triggers whether that is food or emotional stress
• IBS-D may require antidiarrheals
• IBS-C may require laxatives or increased fiber to regulate bowels
• Increased physical activity and management options for stress, anxiety, and depression are included in treatment
• Research on probiotics for the treatment of IBS is mixed
• Common triggers include fatty foods, fried foods, highly processed foods, fructose, lactose, fructans, galactans and polyols
• Dairy and gluten may be fine for many people not suffering from lactose intolerance or gluten sensitivity
• FODMAPS are fermentable

IBD vs. IBS

• IBD has UC - 13.9 per 100,000 and CD - 8.3 per 100,000
• Peak age of onset 20-30 and 60-70
• Equally common in men and women
• For symptoms IBD is Diarrhoea, bloody stools, crampy abdominal pain, fever, weight loss, fatigue and IBS is Diarrhoea predominant, Constipation predominant, Alternating diarrhoea and constipation, Abdominal cramps and Bloating
• IBD investigations will show abnormal blood tests and colonoscopy
• IBD treatment involves Anti-inflammatory agents, Immunosuppressive agents and steroids
• Dietary modification is used to treat IBS
• Dietary modification, anti-diarrheals and anti-depressants are used as treatment IBD has Anti-inflammatory agents, Immunosuppressive agents and Steroids
• IBD Prognosis is A long-term condition requiring continuous monitoring Surgery is required in some patients. Increased risk of colorectal cancer compared to the normal population
• Dietary modifications are generally used for IBS treatment

Massage and IBS

• Abdominal massage during flares is a possible local contraindication
• Avoid the abdomen during massage if it causes discomfort

Diverticulosis

• Characterized by Diverticula: balloon-like pouch that can form along the wall of any hollow structure in the body
• True diverticula includes all four layers of intestinal wall (mucosa to serosa)
• Pseudodiverticula is the mucosa and submucosa poke through and past muscle layer and are covered only by serosa (more common)
• The most common affected area is the sigmoid colon
• It affects areas where vessels traverse muscle layer
• The prevalence increases with age
• Less than 10% younger than 40
• 20% at age 40
• 60% at age 60
• Most patients are older than 50 years and the mean age at presentation appears to be about 60 years
• The etiology of diverticulosis includes:
• High pressure in the lumen
• A low fiber diet and constipation may cause it
• Vague abdominal pain, BM irregularity as well as Genetic CT disorders (i.e. Marfan and Ehlers Danlos syndromes) are also factors
• It's usually asymptomatic unless complications occur
• Often an incidental finding on colonoscopy
• If the diverticula worsens or gets infected it can cause various complications such as:
• Diverticulitis (1-4% of patients)
• Diverticular bleeding (5-15% of patients)
• Fistula

Diverticulitis

• Consists of Inflammation of infection of diverticula often due to impacted fecal matter and associated colonic bacteria
• Can result in perforation and peritonitis
• SSx: LLQ pain, constant fever, perhaps palpable mass in LLQ d/t inflammation, abdominal guarding, rigidity and tenderness
  • Note that hematochezia is RARE with an acute diverticulitis flare

Diverticular Bleeding

• As a diverticulum herniates, the penetrating vessel responsible for the wall weakness at that point becomes draped over the dome of the diverticulum, and is susceptible to bleeding
• It typically occurs in the absence of diverticulitis
• GP suspects diverticulosis based on SSx and is confirmed by colonoscopy or barium x-ray
• Colonoscopy is used when bleeding is present – best to determine source
• CT is performed if severe pain is present
• Treatment
• Reduction of pressure and spasms
• High fiber diet and increasing fluid intake
• Uncomplicated bleeding is self-limiting and does not require treatment
• If bleeding continues, curettage is performed during colonoscopy
• Recurrent bleeding may require colectomy
• TX - antibiotics to limit bacterial overgrowth, and high fiber diet

Massage and Diverticulosis

• A local contraindication
• Avoid the abdomen during massage if it causes the patient discomfort
• For patients with diverticulitis, avoid massage until the condition has been treated

Hemorrhoids

• Swollen blood vessels located in the anal canal (internal hemorrhoids) or around the anus (external hemorrhoids)
• It's a very common condition, and nearly 3 out of 4 adults will have hemorrhoids in their lifetime
• Prolonged pressure on the anus can cause hemorrhoids which includes prolonged sitting, pregnancy and childbirth, obesity and constipation
• Internal hemorrhoids often cause rectal bleeding, but minimal pain as well as Bright red blood
• External hemorrhoids can fill with blood, enlarge, and cause discomfort
• if irritated, they may itch or bleed
• Diagnosed via digital rectal exam (DRE) or visual inspection
• Conservative treatment is often curative and includes:
• Eat high-fiber foods as well as topical treatments such as topical witch hazel, corticosteroids
• Phenylephrine is a sympathomimetic that vasoconstricts blood vessels
• Soak regularly in a warm bath or sitz bath
• If these treatments do not bring improvement or relief, surgical removal may be necessary

Massage and Hemorrhoids

• No contraindications
• Be cautious of patient positioning and comfort

Appendicitis

• It is the inflammation of the vermiform appendix
• A common surgical emergency of the abdomen which affects 10% of the population
• Incidence is highest in the 10-19 year old age group
• The primary cause is obstruction
• Other causes are Fecolith, Fibrosis, Parasite infection, Children: lymphoid hyperplasia d/t infection
• First SSx: periumbilical pain w/ nausea, vomiting, and anorexia
• Nausea passes and pain shifts to RLQ
• Can include:
• Positive McBurney's sign, Rovsing's sign, psoas sign, obturator sign
• Positive rebound tenderness
• Abdominal guarding
• Low grade fever
• Children have more vague pain pattern
• Pregnant women and elderly have milder tenderness
• Complications include Rupture/Perforation
• Increases risk of rupture/perforation with increased age, more common in males
• Can lead to abscess formation, intra abdominal infection, sepsis
• Initial relief of pain, followed by high fever and peritonitis
• Inflammation and scarring of fallopian tube can cause infertility
• Suspected on Hx and PE
• Increased WBC on CBC and blood tests
• CT or US may be performed
• Exploratory laparoscopic surgery performed to confirm

Massage and Appendicitis

• It is an absolute contraindication
• Patient needs emergent medical treatment

Peritonitis

• Inflammation of the inner membrane that lines the abdominal cavity and abdominal organs
• It's most commonly caused by secondary infection
• Classified based on etiology
• Spontaneous Bacterial Peritonitis (SBP; aka primary):
• It's the development of ascitic fluid infection without an evident intra-abdominal infection
• Most often a complication of advanced cirrhosis
• Secondary Peritonitis:
• Much more common than SBP
• Infectious disease of intra-abdominal organs spreads to the peritoneum
• It often occurs as a compilation of ruptured organs like appendicitis and a perforated colon/diverticula
• Signs and Symptoms
• Fever, N/V, chills
• Sudden, severe abdominal pain worse with movement Abdominal tenderness
• Complications
• Dehydration, and electrolyte imbalances as well as sepsis It involves surgery to remove infected tissue or drain fluid, IV Antibiotics, and pain medications

Massage and Peritonitis

• It is an absolute contraindication
• It's a medical emergency and requires immediate medical attention

Viral Gastroenteritis

• Viral infection of intestine cause nausea and watery diarrhea and is known as a “stomach flu"
• Rotavirus causes the most common diarrhea in children under 2 years old
• Spread fecal-oral route
• Immunity develops and each subsequent infection is less intense
• Rare in adults
• Occurs in small epidemics and usually heals without consequence:
• Spread fecal-oral route or person-to-person contact, and/or air droplets of vomited virus

Bacterial Gastroenteritis

• Loose stools caused by various bacterial infections
• Bacteria invade and colonize intestine, then cause inflammation and destroy tissue
• Bacterial toxins pre-form in food, then are ingested or released by bacteria growing outside the intestine
• S. aureus or e. coli cause food poisoning from unrefrigerated/contaminated food
• Clostridium botulinum: botulism caused by canned food
• Lytic bacteria: enterotoxigenic bacteria enter colon and destroy tissue
• E. coli: traveler's diarrhea (enterocolitis) caused by contaminated food or water
• Invasive bacteria produce intestinal inflammation, ulcerations, bleeding, and/or perforation includes:
• Shigella and salmonella
• Can enter blood and lymphatics to cause systemic infection

Protozoal Enteritis

• Parasitic infection of the intestine
• More common in those traveling to southern countries
• Giardia lamblia (“Beaver Fever") and Entamoeba histolytica
• Giardia lambia (“Beaver Fever") is an infection of small intestine caused by contaminated water and causes diarrhea and/or malabsorption
• Entamoeba histolytica is anaerobic ameba which is very common in tropical location an infects travelers more than local residents as well as 10% of people have tissue destruction from parasitic metabolism resulting in ulceration

Massage and Infectious Diseases

• Patients should not be in your office if they are feeling unwell
• It's also a contraindication

Intestinal Ischemia

• Disorders which compromises blood flow in segments to the intestine and can affect the LI or SI
• Triggered by Atherosclerosis and arterial Vasospasms:
• Includes any process that reduces intestinal blood flow
• Could be mild, nonspecific symptoms that often goes undiagnosed

Ischemic Colitis

• Blood flow to part of the colon is slowed or even shut off.
• Can be brought on by Hypothermia, Atherosclerosis, Volvulus or incarceration

Massage and Intestinal Ischemia

• Intestinal ishcemia is a medical emergency and requires immediate medical treatment
• Its considered an absolute contraindication

Intestinal Atresia

• Characterized by a congenital complete obstructions of the intestinal lumen
• It can cause abdominal distention and bilious emesis in first 2 days of life
• Treatment is with surgical resection with anastomosis of uninvolved segment

Meckel's Diverticulum

• Congenital outpouching of the intestine due to a remnant of embryonic connection between the intestine and umbilicus
• This is also the most common malformation of Gl tract
• Often asymptomatic and undiagnosed
• It can also becomes filled with food or fecolith and become infected or rupture
• Usually Asymptomatic
• Rectal bleeding, epigastric and LLQ pain, nausea
• Intestinal obstruction, volvulus, and/or intussusception
• Is often treated surgically but will cause complications

Massage and Meckel's Diverticulum

• Local Contrindication

Hirschsprung's Disease

• Congenital disorder that occurs when part of the intestine lacks innervation
• The missing nerve networks result in dysfunction and lack of peristalsis.
• Diagnosable by failure to pass meconium as well Small percentage diagnosed later in life: anorexia, distension, bilious vomiting, constipation
• It is treated with colostomy and can involve high fibre diets
• Can cause megacolon, intestinal obstruction, perforation volvulus, and/or intussusception

Massage and Hirschsprung's Disease

• Local Contrindication

Intussusception

• a telescoping/ An intestinal disorder in which a segment of the intestine folds in on itself
• It causes Intestinal and vascular obstruction as well as tissue infraction
• Common in the ileocecal region
• More frequent in Infants and children than adults.
• Adults often develop symptoms as a result of Tumor, or Polp

Intussusception Epidemiology and Etiology

• Most common cause of intestinal obstruction in children younger than 3 years old
• Rare in adults
• Most cases of adult intussusception are the result of an underlying medical condition, such as a tumor
• Children (more common): most cases are idiopathic
• Risk factors: Meckel's diverticulum, Hirschsprung's Disease, intestinal malrotation, family history
• Abnormal growth, also has Acts as “leading edge" to pull bowel into itself to pull bowel itself

Intussesception Signs and Symptoms

• Intermittent abdominal pain, vomiting in an otherwise healthy child, palpable mass in abdomen Children may guard abdomen, knees to chest position

Intussesption Complications and Diagnosis

• Intestinal obstruction on volvulus
• Ischemia and infraction
• Causes sloughing of tissue and blood flow
• Results in intestinal mucosa, blood, and mucus in stool: red, jelly-like stool
• Fluid or air enema to unfold intestine, also usually enough to fix intussusception in children (90%)
• Is diagnosed with fluid or air enema to unfold intestine

Massage and Intussusception

• ABSOLUTE CONTRAINDICATION • Intussusception is a medical emergency and requires immediate medical attention

Volvulus

• Twisting of a loop of intestine around itself and its surrounding mesentery
• Is a serios complication that cause Intestinal Obstruction, Vascular Blockage and/or tissue Infarction
• Mainly occurs in the Segmoid Colon, the Cecum and the Midgut
• Can be caused by Pregnancy, Constipation, from injury of Scar tissue,
• Is often severe abdominal pain

Volvulus Etiology

• Pregnancy in which fetus causes displacement and twisting of colon
• Constipation in which stool acts as pivot point for intestine to twist aroundAbdominal adhesions from injury, surgery, or infection
• Scar tissue creates a physical attachment that can act as a pivot point for the intestine to twist around and Hirschsprung's Disease
• Signs and Symptoms has with Severe abdominal pain, abdominal distention X-ray if w or w/o barium

Volvulus Treatment

• Sigmoidoscopy
• Surgical resection if infarction occurs
• Tubes able to relieve pressure and untwist colon
• It also carries severe abdominal pain and can often need surgical intervention, can lead to rupture of the bowel

Massage and Volvulus

It is an absolute contraindication Volvulus is a medical emergency and requires immediate medical attention

Strangulation

• Trapping and cutting off of blood supply to intestinal tissue
• Herniation in where intenstine is bulging through abdominal wall
• Has steady, severe pain with favor
• Is a form of Gangrene which cause
• Can develop in as few as 6 hours in rare cases Gangrene: tissue damage with significant putrefaction and causes rupture and death if untreated
• Can develop in as few as 6 hours
• Often causes rupture that leads to peritonitis, shock, and if untreated, death

Massage and Strangulation

• Absolute Contradiction

Familial Adenomatous Polyposis

• Autosomal that has numerous colonic polyps
• often diagnosed by the age of 40 With it the body develops so many of these polyps so the person is guaranteed to get this or it has resulted
• Normal Numbers are 15-40% of adults •There are Often a number which are asymptomatic in cases of polyps for testing these
• There is a test with the stool sample for occult blood. If there is blood show, colonoscopy
• Often asymptomatic
• Rectal and/or occult bleeding
• Colectomy at time of diagnosis- May or may not leave rectal remnant-

Colorectal Carcinoma

• Adenocarcinomas that develop in glandular intestinal lining of the colon or rectum
• Due do large lymph supply and vascular relationship to liver, early metastasis to these

Risk Factors for Colorectal Carcinoma

• Family history of colorectal cancer and FAP
• Ulcerative colitis and, to a lesser degree, Crohn's disease
• High fat, low fiber diet
• Smoking and alcohol
• Screening of Colonocopy after the age of 50
• There is a test with the stool sample for occult blood
• Often asymptomatic-Rectal and/or occult bleeding
• Colectomy at time of diagnosis- May or may not leave rectal remnant Surgical resection of colon and local lymph is primary treatment

Colorectal Carcinoma Staging and treatment

• It is a Limited to lining of intestine that covers a polyp STAGE 0: limited to lining of intestine that covers a polyp STAGE 1: spread through space between mucosa and muscle layer STAGE 2: invasion of muscle layer and serosa. 55-85% five year survival rate STAGE 3: extension through se
• Surgical resection is the best treatment for Colorectal Caranima

Massage and Colorectal Carcinoma

• No Contraindication

This quiz explores the differentiating characteristics between Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), focusing on diagnostic criteria and potential biomarkers. It covers the classification of IBS as a functional disorder and the distinction between true and pseudodiverticula. The quiz also addresses contraindications for abdominal massage.