IBS

Question 1

Is IBS more common in males or females

Answer 1

Females

Question 2

What percentage of the population is affected by IBS

Answer 2

15%

Question 3

What is meant by the term functional disorder

Answer 3

No change to structure and no tissue damage

Question 4

IBS signs and symptoms

Answer 4

Lower abdominal pain, abdominal bloating + distension, diarrhoea, extreme urgency, passage of mucus, constipation, depression, anxiety, urinary symptoms, fatigue, dyspareunia

Question 5

What IBS symptoms are more common in the morning

Answer 5

Diarrhoea, extreme urgency, constipation

Question 6

What IBS symptoms are more common at night

Answer 6

Abdominal bloating and distension

Question 7

What are the IBS subtypes

Answer 7

IBS with predominant constipation, IBS with predominant diarrhoea, IBS with mixed bowel habits, IBS unclassified

Question 8

Features of IBS with predominant constipation

Answer 8

More than 25% stool 1 and 2, less than 25% stool 6 and 7

Question 9

Features of IBS with predominant diarrhoea

Answer 9

Less than 25% stool 1 and 2, more than 25% stool 6 and 7

Question 10

Features of IBS with mixed bowel habits

Answer 10

More than 25% stool 1 and 2, more than 25% stool 6 and 7

Question 11

Diagnosis of IBS according to the manning criteria

Answer 11

Chronic or recurrent abdominal pain for at least 6 months + 2 or more of:
* Abdominal pain relieved with defication
* Abdominal pain associated with more frequent stools
* Abdominal pain associated with looser stools
* Abdominal distension
* Feeling of incomplete evacuation after defecation
* Mucus in stools

Question 12

Diagnosis of IBS according to the Rome III diagnostic criteria

Answer 12

Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with 2+ of the following:
* Relieved with defecation
* Onset associated with a change in frequency of stool
* Onset associated with a change in form of stool

Question 13

Diagnostic tests to eliminated other causative factors of IBS symptoms

Answer 13

Colonoscopy, imaging, stool sample test for faecal calprotectin, see if there is bleeding (CBC, ESR)

Question 14

Foods and drinks likely to trigger IBS symptoms

Answer 14

Caffeine, alcohol, carbonated beverages, fatty food, dairy, gluten, some fibres

Question 15

Recommended daily intake of fibres for men and women

Answer 15

Men = 30g, women = 25g

Question 16

What fibres should be avoided by patients with IBS

Answer 16

Rapidly fermented soluble fibres (onion, garlic, barley) and slowly fermentable insoluble fibre (wheat bran, nuts, seeds)

Question 17

What does FODMAP stand for with examples

Answer 17

Fermentable (fructans- wheat, garlic), oligosaccharides (galactans- beans, lentils), disaccharides (lactose), monosaccharides (fructose- honey, watermelon, apples), and, polyols (sorbitol, mannitol)

Question 18

Symptoms of IBS patient ingesting FODMAP containing foods

Answer 18

Abdominal distension and pain

Question 19

Definition of constipation

Answer 19

2 or fewer motions per week, straining and feeling of incomplete evacuation at 25% or more of defecations

Question 20

Causes of constipation

Answer 20

Inadequate dietary fibre, dehydration, inappropriate bowel habits, inadequate physical activity, change in environment, painful anorectal disorders, loss of muscle power

Question 21

What are the 3 types of primary constipation

Answer 21

Normal transit constipation, slow transit constipation, pelvic floor dysfunction

Question 22

Normal transit constipation

Answer 22

Functional disorder, most common, normal motility, normal frequency, hard lumpy stools

Question 23

Slow transit constipation

Answer 23

Decreased frequency

Question 24

Pelvic floor dysfunction

Answer 24

Abnormality in pelvic floor muscles

Question 25

Causes of secondary constipation

Answer 25

IBS, anal and rectal diseases, tumors, hernia, hemorrhoids, low dietary fibre

Question 26

Medications that may cause constipation

Answer 26

Opioids, drugs with anticholinergic effects, 5HT3 receptor antagonists, aluminium and calcium containing antacids, oral calcium or iron supplements, verapamil

Question 27

Danger signs for constipation

Answer 27

Hematochezia, melena, family Hx of colon cancer, family Hx of IBD, anemia, weight loss, anorexia, nausea and vomiting, severe persistent constipation refractory to Tx, new onset or worsening in the elderly without evidence of primary cause

Question 28

Non-pharmacological management for constipation

Answer 28

Increase fibre, increase exercise, identify and treat causes

Question 29

MOA of bulk forming laxatives

Answer 29

Increase bulk and moisture in stool stimulating colonic activity

Question 30

Examples of bulk forming laxatives

Answer 30

Psyllium, ispaghula, sterculia

Question 31

Are bulk forming laxatives suitable in IBS

Answer 31

poorly tolerated in functional bloating so not recommended

Question 32

Are bulk forming laxatives suitable for acute relief

Answer 32

Take 24hrs, up to 2-3 days of therapy may be required

Question 33

Are bulk forming laxatives useful for non ambulant or chronic constipation

Answer 33

No, not recommended

Question 34

What is the gold standard for constipation treatment

Answer 34

Bulk forming laxatives

Question 35

MOA of osmotic laxatives

Answer 35

Pull water into or keep water in colon, expanding or softening stool

Question 36

Examples of osmotic laxatives

Answer 36

Lactulose, sorbitol, macrogol 3350, Mg salts, glycerol, saline laxatives

Question 37

Drawbacks of lactulose

Answer 37

Not very palatable- mix with water/juice/milk, not acute relief- take 1-3 days

Question 38

MOA of glycerol

Answer 38

Osmotic laxative, draws water to lumen and increases intestinal motility to provide acute relief

Question 39

Is sorbitol suitable in IBS

Answer 39

No as it causes abdominal distension

Question 40

MOA of stimulant laxatives

Answer 40

Stimulate intestinal motility

Question 41

Examples of stimulant laxatives

Answer 41

Senna, bisacodyl, sodium picosulfate

Question 42

Are stimulant laxatives suitable in IBS

Answer 42

No as they can cause abdominal cramps and bloating

Question 43

How long do stimulant laxatives take to work

Answer 43

6-12 hrs

Question 44

Which stimulant laxative discolours urine

Answer 44

Senna

Question 45

What are stimulant laxatives the gold standard for

Answer 45

Opioid induced constipation

Question 46

Examples of stool softeners

Answer 46

Docusate (not for acute relief), 50% liquid paraffin (2-3 days onset, leakage), poloxamer (<3 years old, onset 2-3 days)

Question 47

MOA of methylnaltrexone

Answer 47

Competes for opioid receptors in intestine to relieve opioid induced constipation but doesn't cross BBB so it doesn't negate the effects of the opioid

Question 48

MOA of prucalopride

Answer 48

Works on serotonin in the brain to regulate peristaltic reflex

Question 49

What are the 3 types of diarrhoea

Answer 49

Acute, persistent and chronic

Question 50

Definition of diarrhoea

Answer 50

Stools with increased frequency but decreased consistency

Question 51

Definition of acute diarrhoea

Answer 51

Lasting less than 14 days

Question 52

Definition of persistent diarrhoea

Answer 52

Lasting more than 14 days

Question 53

Definition of chronic diarrhoea

Answer 53

Lasting more than 30 days

Question 54

4 types of diarrhoea pathophysiology

Answer 54

Secretory, osmotic, exudative, intestinal transit

Question 55

6 differential diagnoses of chronic diarrhoea

Answer 55

IBS, IBD, malabsorption syndromes, drug induced diarrhoea, laxative abuse, chronic GIT infections

Question 56

Lab tests for patients with diarrhoea

Answer 56

Stool analysis studies, stool test kits, total daily stool volume, endoscopy/colon visualisation, radiographic studies

Question 57

Drugs that may cause drug induced diarrhoea

Answer 57

Laxatives, antibiotics, antihypertensives, cholinergics, cardiac agents, NSAIDs, misoprostol, colchicine, PPIs, H2 receptor antagonists

Question 58

Non-pharmacological management of diarrhoea

Answer 58

Oral rehydration (gold standard), FODMAPs (not beneficial to all patients), bulk forming laxative

Question 59

MOA of opioid antidiarrhoeals

Answer 59

Bind to opioid receptors in intestine to decrease motility and increase absorption

Question 60

Examples of opioid antidiarrhoeals

Answer 60

Loperamide HCl, diphenoxylate and atropine

Question 61

Why do we refridgerate colestyramine for 4 hrs or overnight

Answer 61

Reduce gritty texture and make more palatable

Question 62

Is colestyramine suitable for patients with IBS

Answer 62

No as it causes abdominal distension

Question 63

Medications used for abdominal pain

Answer 63

Peppermint oil, hyoscine butylbromide, mebeverine

Question 64

How do medications for abdominal pain work

Answer 64

Relax smooth muscle in the intestine

Question 65

Examples of psychological therapies in IBS

Answer 65

TCA (amitriptyline or notriptyline), SSRIs (citalopram or fluoxetine)