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IBS and diverticulitis clinical
GI
33
Medical
Graduate
09/18/2010

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Term
what is a diverticulum?
Definition
a balloon-like sac/pouch in the wall of the colon. diverticulosis is the presence of these in a pt, diverticulitis is when they become inflamed.
Term
what is a common symptom of pts with diverticulosis? how is this addressed?
Definition
constipation - which is addressed via 5 servings of fiber daily.
Term
what is the incidence of diverticulosis?
Definition
33-50% for ptx > 50 yrs old, and > 50% for pts > 80 yrs old. it increases w/age
Term
what are pseudodiverticula?
Definition
diverticuli which lack muscle and only involve mucosa/serosa.
Term
what is involved in 95% of diverticulosis pts?
Definition
the sigmoid, often accompanied by excruciating LLQ pain
Term
is diverticulosis often seen in the rectum?
Definition
it is rare to see in the rectum b/c the circumferential longitudinal muscle prevents herniation
Term
what is diverticulosis due to?
Definition
increased intraluminal pressure (often due to lack of fiber) and decreased strength of the bowel wall. there is a questionable relationship between IBS and diverticulosis.
Term
what characterizes uncomplicated diverticulosis? what is the rate of progression to diverticulitis?
Definition
bloatedness, flatulence, abdominal pain and irregular defecation. rate of progression to diverticulitis: 10-25%
Term
how is diverticulosis diagnosed?
Definition
ABD x-ray (not as beneficial), double contrast barium enema, and colonoscopy
Term
what is in the ddx for uncomplicated diverticulosis?
Definition
IBS, carcinoma
Term
what is in the tx for uncomplicated diverticulosis?
Definition
fiber, avoidance of nuts/seeds
Term
what is diverticulitis? what can it result in?
Definition
complicated diverticulosis - which can result in self-resolution, abscess, peritonitis, and obstruction
Term
how do pts with diverticulitis present?
Definition
n/v, abdominal pain, fever, ileus, leukocytosis, and ESR
Term
what is in the ddx for diverticulitis?
Definition
acute appencdicitic, IBD, ischemic colitis radiation induced colitis, and infectious colitis
Term
how is diverticulitis diagnosed?
Definition
CT (best), double contrast barium enema/endoscopy - not recommended
Term
what is tx for diverticulitis?
Definition
fluid status/replacement, NG tube for ileus/obstruction, broad spectrum antibx (triple tx: amp, gent, metro: gold standard).
Term
how often does diverticulitis require sx? what are indications for sx?
Definition
15-30% of cases. indications for sx: free perforation (air) w/fecal peritonitis, suppurative peritonotis due to ruptured abscess, abd/pelvic abscess, fistula obstruction, recurrent diverticulitis, and inability to r/o CA
Term
how common are diverticular bleeds w/diverticulitis?
Definition
47% have minor/painless bleeding w/self resolution. 5% have massive rectal bleeds, which opens concern for hypovolemic shock (hyptension, tachycardia, and syncope)
Term
what is in the ddx for diverticular bleeds w/diverticulitis?
Definition
duodenal ulcer, meckel's diverticulum, and vascular ectasias
Term
what are diagnostic studies for pts with diverticular bleeds w/diverticulitis?
Definition
colonoscopy, angiography, and nuclear scans
Term
how are diverticular bleeds w/diverticulitis treated?
Definition
minor bleed: <2 units of PRBCs. major bleed: >4 units of PRBCs. (order PRBCs on admission) colonoscopy if bleeding persists, then angiography, then sx. complete colectomy if unable to ID site and bleeding persists.
Term
what is IBS?
Definition
a GI disorder characterize by altered bowel habits and abdominal pain *in the absence of detectable structural abnormalities*. no clear diagnostic markers exist, and women present w/IBS 2-3x more often.
Term
what is the prevalance of IBS?
Definition
IBS is the most common dx amoung GI practices, among top 10 for PCPs, and the *most common functional bowel disorder (not structural)
Term
what are the clinical features of IBS?
Definition
abdominal pains, altered bowel habits, gas/flatulence, and upper GI symptoms.
Term
what is the pathophysiology of IBS?
Definition
poorly understood, involves an exaggerated sensory response to visceral stimulation as well as psychosocial/environmental factors (anxiety, depression, somatization, and hx of abuse/stressors)
Term
what psychosocial factors are often specifically involved w/IBS pts?
Definition
depression/anxiety, panic disorders, life stressors, and hx of abuse
Term
how is IBS diagnosed?
Definition
IBS is a dx of exclusion. organic disease must be eliminated and according to the rome criteria, symptoms have to be present for at least 3 months.
Term
what are the rome criteria for IBS?
Definition
likely IBS if: if abdominal pain is relieved with defecation, associated with change in stool frequency or consistency OR if pts experience change in stool frequency/consistency, difficulty in passing stools, sense of incomplete evacuation or presence of mucus in the stool 2x or >25% of the time for 12 wks.
Term
what foods may incite IBS symptoms?
Definition
fatty foods, raw fruit/veggies, caffeine, lactose, and spicy foods
Term
what is tx for IBS?
Definition
reassurance/careful explanation of the functional nature of the disorder. elimination of aggravating foods. fiber/low fat diet. anti-cholingergic rx. psychoanalysis/counseling/*cognitive behavior therapy and stress management.
Term
what was alosetron?
Definition
a 5HT3 antagonist for diarrhea in women which was taken off the market due to concerns about ischemic colitis/severe constipation. it can now be prescribed w/special certification/registration
Term
what is tegaserod? contraindications?
Definition
a 5HT4 receptor agonist for IBS constipated women that stimulates the peristaltic reflex, alters secretion of the intestine and reduces visceral sensitivity. contraindications: severe renal impairment, mod/severe hepatic impairment, hx of bowel obstruction, symptomatic bowel disease, suspected sphincter of oddi dysfunction, or abnormal adhesions, and known hypersensitivity to the drug.
Term
what is the current DOC for constipation IBS?
Definition
lubiprostone which activates Cl channels. it is contraindicated in pregnancy and may cause n/v, diarrhea, and HA.
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