IBS and IBD
What is irritable bowel syndrome? - answer a chronic, relapsing and often life-long
disorder.
It is characterised by the presence of abdominal pain or discomfort, which may be
associated with defaecation and/or accompanied by a change in bowel habit
How is IBS classified? - answerIBS-D (diarrhoea)
IBS-C (constipation)
IBS-M (mixed)
How does IBS present? - answer Abdominal pain >6 months which is
. clearly linked to bowel habit either relieved by defecation (suggesting colonic origin)
. or associated with change in stool frequency or consistency (suggesting a link to
changes in intestinal transit, which might reflect changes in either motor patterns or
secretion)
What are some other features of IBS - answerPain is colicky and generalised
Bloating (more common in women than men), distention or hardness
Abnormal stool frequency, straining at defecation, urgency
Symptoms worsened by eating
Passing mucus per rectum
Most people experience symptoms intermittently, with flares lasting 2-4 days followed
by periods of remission
What are some non-gastrointestinal symptoms - answerLethargy
Headache
Urinary symptoms e.g. nocturia, frequency and urgency of micturition
Depression and anxiety
What are some differentials for constipation - answerFunctional or drug induced
constipation
Hypothyroidism
, What are some differentials for diarrhoea - answerIBD
Gastroenteritis
Hyperthyroidism
What are some other differential diagnosis - answerDiverticular disease
Chronic pancreatitis
Gall stones
Peptic ulcer
GORD
Malignancy
What are some red flag symptoms - answer>50
Short history of symptoms
Documented weight loss
Nocturnal symptoms
Male
Family history of colon cancer
Anaemia
Rectal bleeding
Recent antibiotic use
What might you find on physical examination - answerabdominal or rectal masses
What is Carnett's sign? - answerCarnett's sign can be tested for to determine whether
pain originates from the viscera or myofascia/abdominal wall. To test for Carnett's sign,
the patient should lie down and raise their head or legs against gentle resistance from
the physician
Positive: if this manoeuvre exacerbates pain, this indicates an abdominal wall as
opposed to visceral pain origin
Why would you do a FBC in suspected IBS - answerassess for anaemia, and a raised
platelet count may suggest active inflammation as an alternative cause for symptoms
Why would you investigate ESR/CRP - answermay be raised if there is active
inflammation or infection
How can you exclude coeliac's disease - answerlook at the tissue transglutaminase iga
What is irritable bowel syndrome? - answer a chronic, relapsing and often life-long
disorder.
It is characterised by the presence of abdominal pain or discomfort, which may be
associated with defaecation and/or accompanied by a change in bowel habit
How is IBS classified? - answerIBS-D (diarrhoea)
IBS-C (constipation)
IBS-M (mixed)
How does IBS present? - answer Abdominal pain >6 months which is
. clearly linked to bowel habit either relieved by defecation (suggesting colonic origin)
. or associated with change in stool frequency or consistency (suggesting a link to
changes in intestinal transit, which might reflect changes in either motor patterns or
secretion)
What are some other features of IBS - answerPain is colicky and generalised
Bloating (more common in women than men), distention or hardness
Abnormal stool frequency, straining at defecation, urgency
Symptoms worsened by eating
Passing mucus per rectum
Most people experience symptoms intermittently, with flares lasting 2-4 days followed
by periods of remission
What are some non-gastrointestinal symptoms - answerLethargy
Headache
Urinary symptoms e.g. nocturia, frequency and urgency of micturition
Depression and anxiety
What are some differentials for constipation - answerFunctional or drug induced
constipation
Hypothyroidism
, What are some differentials for diarrhoea - answerIBD
Gastroenteritis
Hyperthyroidism
What are some other differential diagnosis - answerDiverticular disease
Chronic pancreatitis
Gall stones
Peptic ulcer
GORD
Malignancy
What are some red flag symptoms - answer>50
Short history of symptoms
Documented weight loss
Nocturnal symptoms
Male
Family history of colon cancer
Anaemia
Rectal bleeding
Recent antibiotic use
What might you find on physical examination - answerabdominal or rectal masses
What is Carnett's sign? - answerCarnett's sign can be tested for to determine whether
pain originates from the viscera or myofascia/abdominal wall. To test for Carnett's sign,
the patient should lie down and raise their head or legs against gentle resistance from
the physician
Positive: if this manoeuvre exacerbates pain, this indicates an abdominal wall as
opposed to visceral pain origin
Why would you do a FBC in suspected IBS - answerassess for anaemia, and a raised
platelet count may suggest active inflammation as an alternative cause for symptoms
Why would you investigate ESR/CRP - answermay be raised if there is active
inflammation or infection
How can you exclude coeliac's disease - answerlook at the tissue transglutaminase iga
