Irritable bowel syndrome

Question 1

What is the most common condition to cause changes in bowel habits in the world?

1 - IBS
2 - IBD
3 - coeliacs
4 - colorectal cancer

Answer 1

1 - IBS

• classed as a functional bowel disease
• cause has been linked with gut-brain dysfunction

Question 2

What is the incidence of the functional bowel disease called irritable bowel syndrome?

1 - 0.2 - 0.3%
2 - 2-3%
3 - 10-20%
4 - 40-60%

Answer 2

3 - 10-20%

Question 3

Is irritable bowel syndrome more common in men or women?

Answer 3

• women

Question 4

What ages is irritable bowel syndrome more common in?

1 - 10-20 y/o
2 - 20-30 y/o
3 - 40-50 y/o
4 - >70 y/o

Answer 4

2 - 20-30 y/o

Question 5

According to the NICE definition, in order to be diagnosed with IBS a patient must have recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months. The patient must also have >2 of the following that have lasted >6 months. Which one of these is NOT one of the true definitions that confirm a diagnosis of IBS?

1 - improvement of symptoms following defaecation
2 - onset associated with change in stool form
3 - onset associated with chronic diarrhoea
4 - onset associated with change in frequency of stool

Answer 5

3 - onset associated with chronic diarrhoea

Question 6

In IBS patients abdominal pain must also be associated with

• relief following defaecation
• change in bowel habits
• change in stool form

Do patients typically experience IBS symptoms during the evening?

Answer 6

• no

Question 7

The most common condition to cause changes in bowel habits in the world is IBS. According to the NICE definition, to be diagnosed patients have to have abdominal pain for >6 months with:

• relief following defaecation
• change in bowel habits
• change in stool form

In addition, they must have how many of the following:

• altered stool passage (straining, urgency etc.)
• abdominal bloating
• worse after meals
• passage of mucous PR

1 - >1
2 - >2
3 - >3
4 - all of them

Answer 7

2 - >2

Question 8

The most common condition to cause changes in bowel habits in the world is IBS. According to the NICE definition, to be diagnosed patients have to have abdominal pain for >6 months with:

• relief following defaecation
• change in bowel habits
• change in stool form

In addition, they must have >2 of the following:

• altered stool passage (straining, urgency etc.)
• abdominal bloating
• worse after meals
• passage of mucous PR

They must also have other diagnoses excluded. Which of the following is NOT one of the conditions that needs to be excluded?

1 - colorectal cancer
2 - diverticulosis
3 - IBD
4 - coeliacs

Answer 8

2 - diverticulosis

Question 9

In patients with a change in bowel habits, we can use a marker in patients stool to rule out bowel cancer. What is this marker called?

1 - qFIT
2 - faecal calprotecin
3 - CA19
4 - CRP

Answer 9

1 - qFIT

• negative (<10) gives a 99.6% specificity (correctly they do not have cancer)
• positive requires further investigations

Question 10

If a patient has a positive qFIT, which of the 2 would a clinician most likely perform?

1 - ultrasound
2 - nuclear medicine
3 - colonoscopy
4 - CT colonoscopy

Answer 10

3 - colonoscopy
- gold standard, but poorly tolerated in IBS patients

4 - CT colonoscopy
- high radiation, best to avoid in <40-45 y/o

Question 11

In IBS, would a colonoscopy be normal or abnormal?

Answer 11

• typically normal

Question 12

Faecal calprotectin can be used as a measure of inflammation in stool. What is a raised level for faecal calprotectin?

1 - >10ug/g
2 - >50ug/g
3 - >100ug/g
4 - >150ug/g

Answer 12

4 - >150ug/g

Question 13

In IBS, would a stool microscopy, culture and sensitivities test (MC+S) be normal or abnormal?

Answer 13

• normal

Question 14

Would we expect a FBC, CRP and coeliac screen to be normal or abnormal in a patient wit IBS?

Answer 14

• typically should all be normal

Question 15

In IBS we can do a selenium homocholic acid taurine (SeHCAT) test, which is a nuclear test for bile salt absorption. Would we expect to see this normal or abnormal in IBS?

Answer 15

• normal

Question 16

In IBS would we expect any of the following to be abnormal?

1 - lactulose hydrogen breathe test (SI bacterial overgrowth)
2 - lactose hydrogen breathe test (lactose malabsorption)
3 - fructose hydrogen breathe test

Answer 16

• no
• should all be normal in IBS

Question 17

In IBS would we expect colonic transit time studies to be normal or abnormal?

Answer 17

• normal
• rules out obstruction, neurological disorder affecting peristalsis as reasons for constipation

Question 18

In addition to qFIT and colonoscopy, which of the following is NOT a standard investigation a clinician may perform in IBS?

1 - sigmoidoscopy
2 - FBC (anaemia)
3 - coeliac serology
4 - faecal calprotectin

Answer 18

1 - sigmoidoscopy

• vitamin B12 deficiency anaemia can cause other symptoms, such as diarrhoea and/or constipation.

Question 19

What does red stool suggest?

1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat

Answer 19

1 - fresh blood
- bright red suggests colon or rectum is the source

Question 20

What does black stool suggest?

1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat

Answer 20

2 - old blood
- melena from upper GI
- peptic ulcer etc..

Question 21

What does pale stool suggest?

1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat

Answer 21

3 - reduced stercobilin
- biliary obstruction and low stercobilin

Question 22

What does yellow stool suggest?

1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat

Answer 22

5 - excessive fat
- pancreatic dysfunction
- malabsorption

Question 23

What does green stool suggest?

1 - fresh blood
2 - old blood
3 - reduced stercobilin
4 - excessive bile
5 - excessive fat

Answer 23

4 - excessive bile
- seen in diarrhoea

Question 24

In a patient diagnosed with IBS, which of the following is NOT part of the 1st line treatment?

1 - education and reassure patient
2 - lifestyle modification
3 - dietary advise (FODMAP)
4 - senna

Answer 24

4 - senna

Question 25

In a patient diagnosed with IBS with constipation, which 2 of the following is 1st line treatment? 1 - loperamide 2 - lactulose 3 - buscopan/peppermint oil 4 - rifaximin

Answer 25

2 - lactulose - osmotic laxative 3 - buscopan/peppermint oil

Question 26

In a patient diagnosed with IBS with constipation, which 2 of the following is 2nd line treatment? 1 - prucalopride 2 - lactulose 3 - buscopan/peppermint oil 4 - linacliotide

Answer 26

1 - prucalopride 4 - linacliotide - both are secretalogues that increase secretions into bowel and reduce constipation

Question 27

In a patient diagnosed with IBS with diarrhoea, which 2 of the following is 1st line treatment? 1 - loperamide 2 - lactulose 3 - buscopan/peppermint oil 4 - rifaximin

Answer 27

1 - loperamide 3 - buscopan/peppermint oil

Question 28

In a patient diagnosed with IBS with diarrhoea, which 2 of the following is 2nd line treatment? 1 - loperamide 2 - amitriptyline 3 - buscopan/peppermint oil 4 - rifaximin

Answer 28

2 - amitriptyline - tricyclic antidepressant, that have anti-muscarinic effects that essentially reduces peristalsis 4 - rifaximin - antibiotic typically prescribed for travellers diarrhoea

Question 29

Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. What is the incidence of this in adults 1 - 0.1-1% 2 - 1-10% 3 - 20-35% 4 - >50%

Answer 29

2 - 1-10% - may be under reported - 0.5-1 experience persistent incontinence affecting QoL

Question 30

Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. This can be passive or urge incontinence. What is passive incontinence? 1 - unaware involuntary control of bowels 2 - unable to go despite wanting to 3 - aware of episode but still unable to control bowels 4 - unaware and unable to move bowels

Answer 30

1 - unaware involuntary control of bowels - even with functioning sphincters, diarrhoea can lead to insufficient time to reach toilets

Question 31

Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. This can be passive or urge incontinence. What is urge incontinence? 1 - unaware involuntary control of bowels 2 - unable to go despite wanting to 3 - aware of episode but still unable to control bowels 4 - unaware and unable to move bowels

Answer 31

3 - aware of episode but still unable to control bowels - even with functioning sphincters, diarrhoea can lead to insufficient time to reach toilets

Question 32

Faecal incontinence is defined as an inability to control bowel movements, resulting in involuntary soiling, which can be mucoid discharge ti solid stool. This can be passive or urge incontinence. Below are common risk factors for incontinence, except one. Which is this? 1 - younger age 2 - frailty 3 - women (following birth) 4 - neurological or spinal disease 5 - cognitive impairment 6 - rectal prolapse 7 - prior pelvic surgery 8 - prior pelvic radiation

Answer 32

1 - younger age - more common in older ages

Question 33

When assessing a patient with faecal incontinence, once we have performed a full history, what is generally the first examination we should perform? (all of these could be done, but which should be first) 1 - defaecating proctogram 2 - endoscopy 3 - axial imaging (transverse) 4 - assess pelvic floor muscles

Answer 33

4 - assess pelvic floor muscles