IBS (irritable bowel syndrome) is common amongst young people, females more often than males, and usually presents with coexisting psych disorders, chronic fatigue syndrome or fibromyalgia (you'd think it's a factitious disorder, but something is indeed causing your patient to have the runs, but it's just not something you can prove with any diagnostic tests).
there's NO inflammation/ abnormalities histologically.
symptoms include: crampy abdominal pain, along with alteration of bowel habit (constipation, diarrhea, alteration between both), brought on by irritants/ precipitating factors such as certain foods/ stress.
it's not an organic problem, so:
no mucus or pus in stool.
not guiaic positive (no inflammation, so no cause for bleeding).
no nocturnal diarrhea.
ROME diagnostic guidelines for IBS = 12 weeks of abdominal discomfort and pain with:
- relief with defecation
- change in frequency of stool (once a week or more than 3 x a day)
- change in form of stool
really, IBS is a diagnosis of exlusion, having ruled out the main etiologies such as infectious, neoplastic, organic causes for diarrhea etc.
treatment for IBS includes TCA/ SSRIs for diarrheal form of IBS (remember the coexisting psych disorder) and imodium for severe cases (presenting with fecal incontinence etc); fiber bulking agents and adequate hydration for constipation forms of IBS.
now, IBDs are a bit of an opposite to IBS. IBDs are all about inflammation!
the two main stars of IBDs are Ulcerative Colitis (UC) and Crohn's disease. these two diseases differ a lot though, and once you've read the table below, you'll learn how not to mistake one for the other =)
| Ulcerative Colitis | Crohn's |
| distal most rectum (anus not involved) | terminal ileum involvement mostly, |
| | but affects anus --> mouth. |
| | gum to bum |
| columnar mucosa | transmural |
| symmetric, continous disease | skip lesions / cobblestone appearance |
| ~proctitis | |
| ~proctosigmoiditis | |
| ~pancolitis | |
| bloody diarrhea | watery diarrhea (can be bloody) |
| < colon function so < H2O reabsorption | presence of undigested food because |
| > ulceration so blood | of small bowel involvement. |
| chronic process | |
| if accute, think of infectious colitis or | if accute think of yersenia |
| ischemic colitis | |
| pANCA positive | ASCA positive |
| (perinuclear antineutrophil cytoplasmic ab) | (antiyeast saccharomyces ceverisiae ab) |
| flexible sigmoidscopy and biopsy | upp. GI small bowel series (term. Ileum) |
| | and biopsy |
| Rx | |
| sulfasalazine, mesalamine | sulfasalazine * |
| steroids | works @ colon, not small intest coz 5ASA |
| total proctocolectomy (curative) | cleaved at distal ileum by colonic bacteria |
| | so use MESALAMINE *directly 5ASA* |
| | broad spectrum antibiotic |
| | steroids |
| | TNF-alfa for severe crohn's. |
| | anti inflammatory: azathioprine/ mercaptopurine |
| | if meds fail --> surgical resection (non curative) |
| complications | |
| high risk colonic cancer | abcess formation |
| haemorrhage | fistulas |
| toxic megacolon | fissures |
| bowel obstruction | malabsorbtion coz small intest. Invovled |
| | toxic megacolon |
mnemonic for U.C:
CECAL PLUMB
- continuous
- extraintestinal symptoms at eyes, joints, skin and liver
- cancer risk
- abcess in crypts
- large bowel only
- psuedopolyps
- lead pipe (loss of haustra)
- ulceration
- mucosa/ submucosa involvement
- bloody diarrhea
- cobblestones
- high temperature (ongoing inflammation)
- reduced lumen size (thickening from sclerosis)
- intestinal fistulas
- skipped lesions
- transmural
- malabsorbtion
- abdominal pain
- submucosal fibrosis
extra intestinal manifesations of IBDs are erythema nodosum, abcess at mouth ulcers (crohn's), pyoderma gangrenosum, arthritis, uveitis, iritis, primary sclerosing cholangitis (fibrosis and sclerosis of bile duct). these extra intestinal disorders do not follow activity of bowel disease and are treated by treating the underlying IBD + according to presenting symptoms.
