Term
| How do you make a diagnosis of IBD? |
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Definition
Functional bowel disease with no obvious anatomic/physiologic problem, characterized by abdominal pain and change in stool habits.
Classically, pain presents with change in frequency or quality of stool in the context of physical/emotional stressors.
1) Manning (>3)
- Pain relieved on defecation
- More frequent stools with onset of pain
- Looser stools with onset of pain
- Visible abdominal distension
- Sense of incomplete evacuation
2) ROME
- Recurrent abdominal pain at least 3 days per month for 3 months with at least 2 of:
- Improvement with defecation, onset associated with change in frequency of stool, onset associated with change in form of stool |
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Term
| What are the 4 general categories of IBS symptoms? |
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Definition
1) Diarrhea predominant (D-IBS)
2) Constipation predominant (C-IBS)
3) Alternating diarrhea-constipation (A-IBS)
4) Normal bowel movements |
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Term
A patient presents with diffuse abdominal pain and diarrhea. He claims that the diarrhea gets worse after arguments with his father and that it is also more frequent when he feels the pain.
What initial evaluations are indicated for this patient? |
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Definition
This could be D-IBS so you need to do 5 important things
1) Blood count and electrolytes
2) Stool for ova & parasites (Giardia)
3) 24h stool collection
4) Celiac testing
5) Breath test (small bowel bacterial overgrowth) |
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Term
| What initial evaluations are indicated if IBS with constipation is suspected? |
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Definition
1) Blood count and electrolytes
2) Calcium levels
3) Thyroid levels (hypothyroidism) |
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Term
| What does small intestinal bacterial overgrowth (SIBO) have to do with IBD? |
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Definition
Often presents like D-IBD and must be ruled out with breath test.
Often occurs WITH IBD, and is treated with cipro or metronidazole. |
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Term
What are the effects of IBD on each of the following?
1) Visceral sensation
2) Inflammation
3) Motility
4) Psychological |
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Definition
1) Visceral hypersensitivity and diffuse abdominal sensitivity (pain, bloating, urge to defecate)
2) Increased TNF-a and IL-6, with some evidence for lymphocytic infiltration of myenteric plexus (not certain).
3) Inconsistent, but delayed/increased motility may explain C-IBS vs. D-IBS
4) Patients with IBS are more likely to have suffered physical, sexual or emotional abuse. |
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Term
| What is the role of psychological dysfunction in IBD? |
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Definition
Patients with IBS are more likely to have suffered physical, sexual or emotional abuse.
Corticotropin releasing factor (CRF), which causes anxiety and depression, may also increase abdominal pain and colonic motility more so in patients with IBD. |
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Term
| What are the 3 important components to successful treatment of IBD? |
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Definition
1) Therapeutic relationship
2) Patient education
3) Medical therapy
- Treat diarrhea or constipation as well as pain. |
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Term
| What is the ROME criterion for IBD? |
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Definition
3-3-2
Recurrent abdominal pain 3 days per month in the last 3
months associated with at least 2 of the following:
1) Improvement with defecation
2) Onset associated with a change in frequency of stool
3) Onset associated with a change in stool form |
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