All of the following are present in irritable bowel syndrome (IBS), except:
Correct Answer B:
The Rome criteria are standardized symptom-based criteria for diagnosing irritable bowel syndrome (IBS). The Rome criteria require the presence of abdominal pain or discomfort for at least 3 days per month in the last 3 months along with ≥2 of the following: (1) improvement with defecation; (2) onset (of each episode of discomfort) associated with a change in frequency of defecation, or (3) change in consistency of stool.
Other symptoms of IBS include abdominal pain or cramping, a bloated feeling, gas (flatulence), diarrhea or constipation, with sometimes alternating bouts of constipation and diarrhea and mucus in the stool.
Symptoms not consistent with irritable bowel syndrome should alert you to the possibility of an organic pathology.
Inconsistent symptoms include the following:
A 24-year-old white female presents to the office with a 6 month history of abdominal pain. A physical examination, including pelvic and rectal examinations, is normal.
Which one of the following would indicate a need for further evaluation?
Correct Answer E:
Irritable bowel syndrome (IBS) is a benign, chronic symptom complex of altered bowel habits and abdominal pain. It is the most common functional disorder of the gastrointestinal tract. Symptoms not consistent with irritable bowel syndrome should alert the clinician to the possibility of an organic pathology.
> Meals may precipitate pain, and defecation commonly improves pain (choice A).
> Altered bowel habits (choice B) are characteristic of IBS. Postprandial urgency is common, as is alternation between constipation and diarrhea.
> Clear or white mucorrhea (choice C) of a noninflammatory etiology is commonly reported.
> Patients frequently report increased amounts of bloating (choice D) and gas.
A 26-year-old female presents with a 1-year history of recurring abdominal pain associated with intermittent diarrhea, 5-7 days per month. Her pain improves with defecation. She denies blood in her stool and weigh loss. Laboratory tests (including a CBC, chemistry profile, TSH level, and antibodies for celiac disease) came back normal.
Which one of the following would be most appropriate at this point?
This patient has classic symptoms of irritable bowel syndrome (IBS) and meets the Rome criteria by having 3 days per month of abdominal pain for the past 3 months, a change in the frequency of stool, and improvement with defecation. According to current clinical guidelines IBS can be diagnosed by history, physical examination, and routine laboratory testing, as long as there are no warning signs. Warning signs include rectal bleeding, anemia, weight loss, fever, a family history of colon cancer, onset of symptoms after age 50, and a major change in symptoms. Antidiarrheal agents such as loperamide are generally safe and effective in the management of diarrheal symptoms in IBS.
→ Colonoscopy, CT, and GI contrast studies are not indicated.
→ A gluten-free diet would not be indicated since the antibody tests for celiac disease are negative.
A 41-year-old woman presents with a six months history of recurrent episodes of abdominal pain, bloating, and abdominal distention. She says her pain is worse after eating and is most often felt on the left side. It improves with passage of stool; however, she feels that the bowel evacuation is not complete. She reports alternation between loose and hard stools. She denies fever and weight loss. She notes that in the past she had one episode of traveler’s diarrhea when she visited India at the age of 30. Other than that she did not have gastrointestinal symptoms in the past. Your presumptive diagnosis is irritable bowel syndrome (IBS).
Diagnosis of IBS can be made on the basis of symptoms alone, in the absence of which one of the following alarm features?
Correct Answer A:
Irritable bowel syndrome (IBS) is considered a functional gastrointestinal disorder, as it does not have a known organic cause. The primary symptoms of IBS are abdominal discomfort or pain in association with change in bowel habits with frequent diarrhea or constipation. There are several associated symptoms such as urgency of bowel movements, a feeling of incomplete evacuation, bloating and flatulence. In some cases, symptoms worsen with food intake and are relieved by defecation.
Diagnosis of IBS can be made on the basis of symptoms alone, if there are no alarm features such as age of onset greater than 50 years (choice A), weight loss, gross blood in stool, systemic signs of infection or colitis, or family history of Inflammatory bowel disease. IBS can affect people of all ages but is more common between 15-40 years of age. Age older than 50 years is considered an alarm feature due to possibility of colon cancer.
→ The abdominal pain in IBS is chronic, mild to moderate in intensity and can involve any part of abdomen. The site of pain may change from time to time (choice B).
→ Lower abdominal pain relieved by defecation is considered characteristic of IBS. Feeling that a bowel movement is incomplete (choice C) is a common feature of IBS.
→ Approximately one third of IBS patients have diarrhea as predominant bowel habit (choice D), approximately one third have constipation as predominant bowel habit (choice E) and the remainder have diarrhea alternating with constipation as is present in the case described.
Key point:
Irritable bowel syndrome may be diagnosed on the basis of symptoms alone, if there are no alarm features such as age of onset greater than 50 years, weight loss, gross blood in stool, systemic signs of infection or colitis, or family history of Inflammatory bowel disease.
Which of the following beta blockers used to treat hypertension is contraindicated in an asthma patient?
Beta blockers are either beta 1 selective where they only block the receptors on the heart. Or they can be non-selective and block both beta 1 and beta 2 receptors. Blockade of beta 1 receptors leads to a decrease in heart rate. Blockade of the beta 2 receptor leads to bronchoconstriction. This should be avoided in asthmatic patients.
Therefore it is best to only given beta 1 selective beta blockers to asthma patients when treating their hypertension. This group includes the following four: acebutolol, atenolol, esmolol and metoprolol.
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