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Irritable bowel syndrome (Clinical presentation (Abdo pain (Site Abdo,…
Irritable bowel
syndrome
Definition
Functional bowel disorder no organic cause
with abdo pain and diarrhoea/constipation
Epidemiology
Common
Onset <40y
F>M
Pathophysiology
Altered GI motility +/- enhanced visceral perception
(brain-gut axis)
Giardia infection may trigger
Unclear cause
Chronic symptoms, inc by stress, gastroenteritis, menses etc
Classification
IBS diarrhoea
IBS mixed
IBS constipation
Clinical
presentation
Altered bowel habit
Constipation, diarrhoea
Tenesmus
Abdo pain
Site
Abdo, diffuse/poor localisation
Onset
Sudden or insidious
Character
Colicky
Radiation
May have backache
Associated symptoms
Bloating
Diarrhoea/constipation
Flatus
Tenesmus
Nausea
Timing
Constant or intermittent
Exacerbating/relieving factors
Exacerbating - stress, menses, GI infection
Relieving - flatus, passing stool
Severity
Varied
Bloating
Nausea
Diagnosis
Examination
Usually normal
May have distension, tenderness
Investigations
Often not required
Bedside
Bloods
FBC, CRP, LFTs, U+Es, B12, folate
Coeliac screen
Cancer markers (CEA, CA125)
Stool culture
If diarrhoea
MCS, C difficile toxins
Imaging
AXR - suspected Crohn's
USS abdo - ovarian malignancy
Endoscopy/colonoscopy - >50 and red flags
History
PC - symptoms, red flags (weight loss, blood etc.)
PMH - other functional disorders, known bowel disease
DH - any affecting bowel motility, allergies
FH - bowel disease, IBS, cancers
SH - stress, diet, alcohol, smoking
Management
Referral
Gastro (diagnostic uncertainty)
Psychotherapist (stress, depression)
Gynae (suspected gynae cause)
Pain clinic (chronic pain syndrome)
Medical
Laxatives
E.g. bisacodyl, Na picosulfate, isophagula husk
Avoid lactulose (bloating, flatulence)
Anti-darrhoeals
E.g. loperamide, bulkers
Antispasmodics
Indication: colicky pain, bloating
E.g. mebeverene
Visceral pain
Indication: persistent pain
E.g. TCAs (amitryptilline
Conservative
Education, reassurance
Diet (avoid triggers)
Psychological
CBT, hypnosis