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COLONUL IRITABIL

Boal funcional caracterizat prin tulburri de tranzit, ce const n general din alteranana diareei cu constipaia, dureri abdominale difuze (crampe), uneori emisia de mucus.
Nu fac parte din tablou: rectoragia, anemia, scderea ponderal

COLONUL IRITABIL
TABLOU CLINIC:
dureri abdominale: frecvent caracter colicativ, sau discomfort abdominal, simptome ce dispar n perioadele de relaxare, concediu. tulburri de tranzit: caracteristic alternana diaree constipaie; scaune sub form de schibale acoperite cu mucus; diaree la emoie, matinal. emisie de mucus fr snge
balonarea frecvent, ameliorat de emisia de gaze.

COLONUL IRITABIL-DIAGNOSTIC:

Implic excluderea bolilor organice ale colonului!


CRITERIILE MANNING: -dureri abdominale care cedeaz dup emisia de scaune -scaune ce devin mai frecvente i mai moi n prezena durerii -balonare, distensie abdominal

-senzaia de evacuare incomplet a rectului


-eliminarea de mucus la scaun

-carecterul imperios al defecaiei.

COLONUL IRITABIL-DIAGNOSTIC:
CRITERIILE ROMA: -simptome continue sau recurente de:

durere continu sau discomfort care cedeaz la


defecaie i/sau asociat cu modificri n frecvena scaunului, consistena scaunului

i dou sau mai multe din urmtoarele pt. cel


puin un sfert din ocazii sau zile:

-frecvena scaunului modificat, forma scaunului alterat, pierderi de mucus, balonri sau senzaie de distensie abdominal

COLONUL IRITABIL-DIAGNOSTIC:

IBS: Rome II criteria (2000)


At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features: (1) Relieved with defecation; and/or (2) Onset associated with a change in frequency of stool; and/or (3) Onset associated with a change in form (appearance) of stool.

COLONUL IRITABIL-DIAGNOSTIC:

IBS: Rome II criteria (2000)


Symptoms that cumulatively support the diagnosis of IBS:
Abnormal stool frequency; Abnormal stool form (lumpy/hard or loose/watery

stool); Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); Passage of mucus; Bloating or feeling of abdominal distension.

COLONUL IRITABIL
DIAGNOSTIC PARACLINIC:

anuscopie, rectoscopie, colonoscopie, irigografie pt. excluderea patologiei organice de colon.


gastroscopie excluderea suferinei gastrice ecografie abdominal i pelvin pt. patologia pancreasului, colecistului, organelor genitale.

evaluarea radiologic a intestinului subire sau enterosopie pt. patologia organic enteral.

COLONUL IRITABIL
DIAGNOSTIC DIFERENIAL:
Neoplasmul anorectal i de colon Boli inflamatorii colonice (RUH, BC) Diverticuloza colonic i diverticulita Deficitul de lactaz Dispepsia funcional.

COLONUL IRITABIL
TRATAMENT: dificil datorit componentei psihice.
1.Dietetic: se evit alimentele care produc simptome; n caz de constipaie, diet bogat n fibre +/- Forlax.
2. Medicamentos: -antidiareice: Smecta, Imodium. -antispastice: Spasmomen, Debridat, Ditecel, NoSpa; se caut preparatul cel mai eficient pentru pacient. -sedative: Hidroxizin, Rudotel, psihoterapia.

COLONUL IRITABIL

IBS: Patient's concerns


What is IBS?
DOCTOR

Can it be treated?

Do I have cancer?

Where is the toilet?

I have this pain in my abdomen

I can't lead a normal life

IBS: Doctor's concerns


Hidden agenda narcotics,laxatives, benefits

Serious disease

Psychological comorbidity

Shall I refer?

Recent stressful event

Impaired daily function


Drossman et al, 1995; 1997