Irritable Bowel Syndrome (IBS) - PDF

Irritable bowel syndrome Rehab A Omran  Objectives To define irritable bowel syndrome and list its causes Recognize the symptoms of IBS Differentiate between constipation-predominant and diarrhea- predominant Determine how to investigate for IBS Construct a non-pharmacologic an...

Irritable bowel syndrome Rehab A Omran  Objectives To define irritable bowel syndrome and list its causes Recognize the symptoms of IBS Differentiate between constipation-predominant and diarrhea- predominant Determine how to investigate for IBS Construct a non-pharmacologic and pharmacologic treatment plan List complications of IBS  Definition of IBS Notorganic onandoff Most common functional gastrointestinal disorder that is disease associated with abdominal discomfort or pain and bowel motility dysfunction which leads to diarrhoea or constipation. Worldwide prevalence rates ranges between 10–15%. Up to 40% of cases seen gastroenterologist clinics are patients with IBS. Females > Males.  functional Pathophysiology The exact cause is not clear, but several theories has been stated somegeniticfactor Relatedtostress _BrainGutSyndrome That'smean stressstimulate eitherconstipation Intestine ORDiarrhea resabalhypersensitivity Lactelage orallergen Pathogen say Intistine  GI symptoms IBS is characterized by chronic abdominal pain and changes in bowel habits. Abdominal pain, typically related to defecation. i Ploating Altered bowel habits: diarrhea and/or constipation. C Manifestation Other gastrointestinal symptoms: Nausea, reflux, early satiety Abdominal bloating  NON-GI symptoms usually Manifestation Generalized somatic symptoms (e.g., pain or fatigue) Back Pain Increased urinary frequency and urgency e Dysmenorrhea Disturbed sexual function a  Diagnosis Symptoms sign clinicalManifestation y Diarrhea Diagnostic criteria (Rome IV 2016) Abdominal pain www.disakd In the preceding 3 months, there should be at least 1 day per week in the last 3 months of recurrent abdominal pain 241 associated with two or more of the following: with Improveby 1. Related to defecation. DiarrheaORconstipation 2. Onset associated with a change in frequency of stool. 3. Onset associated with a change in form (appearance) of stool Emg  if thereisanysignof TheseThisNotIBD Red flags Is 081,1 ContainNot Signs or symptoms of gastrointestinal bleeding. diarrhea Unexplained iron deficiency anemia. Ananta Unintentional weight loss. Tagni Fever. Palpable abdominal mass or lymphadenopathy on exam. Chron's Nocturnal defecation. Family history of inflammatory bowel disease, colon cancer and celiac disease. If It's fy.mg Onset of symptoms age ≥50 years and have not had colon cancer screening. eaf Sudden or acute onset of new change in bowel habit. constipation i.ws Tfwgg fda we  Differential diagnosis Chronicdiarrhea Inflammatory bowel disease: Crohn's disease and ulcerative colitis. Malabsorption syndromes: Celiac disease. Obstruction of the intestine: Intestinal pseudo-obstruction in DM and scleroderma. Abuse of medications: Laxatives. Lactose intolerance. Bile AcidMalapsorption Endocrine disorders: Hypothyroidism, Hyperthyroidism, DM and Addison’s disease. Diverticulitis. Zollinger-Ellison syndrome. Related to Morning Nocturnalcouldbe hyperthyrodisee DM digging notT.BR  Specific investigations (for exclusion) forDiagnosis 1. Lactose intolerance tests.VHining ima 7-Serum Calcium malapsurbion 2. Hydrogen Breath test for bacterial REÉeria 8-Stool tests: For Multiple overgrowth. antigens (eg. Clostridium 3. C-reactive protein (CRP) difficile ) 3. Small bowel biopsy Chrons celiac 4. Erythrocyte sedimentation rate (ESR) 9-Stool might be examined for 5. Tissue transglutaminase antibody celiac bacteria or parasites, or a 6. Thyroid Hormone ( for hypo- digestive liquid produced in your hyperthyroidism ) liver (bile acid). 10-Complete blood count: Mainly for anemia  Imaging Forother Search To exclude 1. Colonoscopy: to examine the entire length of the colon ( for alarm symptoms) 2. X-ray or Abdominal CT scan: to rule out other causes of symptoms. 3. Upper Endoscopy: look for overgrowth of bacteria. 4. MR Enterography 5. ultrasonography  How to manage IBS management Patients with IBS are often worried that their symptoms are due to a serious disease such as cancer. Firstshouldtoexclude cancer A positive diagnosis of IBS with an explanation of the symptoms and reassurance is often helpful and may require no further investigation or treatment. Current strategies for the treatment of IBS include therapies target central and end-organ pathways. Brain Gut Antidepressant Antistress  CangiveMedsActonBrainORAct ongut Avoid factors that triggers IBS Affective disorders eg; depression and anxiety. Treatstress Gastrointestinal infection. Avoid Some types of food eg; coffee, dairy products, high protein diet, processed food, alcohol. can cause diarrhea Antibiotic therapy. Pelvic surgery.searchfor Adhesions Any Physical or psychological abuse. Au b estate  BrainGut Treatanexity Pharmacological management TreatDepression andDian constipation LocalyActingAntibioticPonte Both gut Alteration of microbiota (antibiotic): rifaximin ftp.fhfben ieonstipitatio stentileDW Diarrheaz Anti-diarrheal drugs for bowel frequency: loperamide, codeine phosphate y axis don'tGiveBecausewewantwas FI 115 11669 Constipation: 5-HT4 receptor agonist (prucalopride) Smooth muscle relaxant for pain (anticholinergic): mebeverine hydrochloride, dicycloverine hydrochloride no Antidepressant for psychological symptoms: -SSRI(paroxetine) for constipation -Tricyclic(amitrytriptylin) for diarrhea  If Complications eFWO.am If severconstibation Chronic constipation or diarrhea can cause: hemorrhoids. In addition, IBS is associated with: Poor quality of life: many people with moderate to severe IBS report poor quality of life. Research indicates that people with IBS miss three times as many days from work as do those without bowel symptoms. Mood disorders: experiencing the signs and symptoms of IBS can lead to depression or anxiety. Depression and anxiety also can make IBS worse. It's notorganic  Kumar and Clark's Clinical Medicine, gastroenterology, Adam Feather David Randall Mona Waterhouse, clinical medicine, 19th June 2020, pg1188 [Internet]. 2021 [cited 30 October 2021]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051916/ About IBS. 2021. How is IBS diagnosed? - About IBS. [online] Available at: [Accessed 29 October 2021]. Wilkins, T., Pepitone, C., Alex, B. and Schade, R., 2021. Diagnosis and Management of IBS in Adults. [online] Aafp.org. Available at: [Accessed 29 October 2021]. References Wikidoc.org. 2021. Irritable bowel syndrome differential diagnosis - wikidoc. [online] Available at: [Accessed 29 October 2021]. Irritable bowel syndrome - Knowledge @ AMBOSS [Internet]. Amboss.com. 2021 [cited 30 October 2021]. Available from: https://www.amboss.com/us/knowledge/Irritable_bowel_syndrome Lehrer JK. Irritable Bowel Syndrome. In: Anand BS Irritable Bowel Syndrome. New York, NY: WebMD.http://emedicine.medscape.com/article/180389-overview#a1. April 4, 2017. Accessed April 5, 2017.