COLONUL I RI TABI L

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 I RI TABI L
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 I RI TABI L-DI AGNOSTI C:
Implic excluderea bolilor organice ale colonului!
CRI TERI I LE MANNI NG:
-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 I RI TABI L-DI AGNOSTI C:
CRI TERI I LE 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 I RI TABI L-DI AGNOSTI C:
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 I RI TABI L-DI AGNOSTI C:
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.
IBS: Rome II criteria (2000)
COLONUL I RI TABI L
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 I RI TABI L
DIAGNOSTIC DIFERENIAL:
Neoplasmul anorectal i de colon
Boli inflamatorii colonice (RUH, BC)
Diverticuloza colonic i diverticulita
Deficitul de lactaz
Dispepsia funcional.
COLONUL I RI TABI L
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, No-
Spa; se caut preparatul cel mai eficient pentru
pacient.
-sedative: Hidroxizin, Rudotel, psihoterapia.
COLONUL I RI TABI L
IBS: Patient's concerns
DOCTOR
What is IBS?
Do I have
cancer?
I can't lead
a normal life
I have this
pain in my
abdomen
Where is
the toilet?
Can it be
treated?
IBS: Doctor's concerns
Psychological
comorbidity
Serious
disease
Hidden agenda
narcotics,laxatives,
benefits
Shall I refer?
Recent
stressful event
Impaired
daily
function
Drossman et al, 1995; 1997