GASTROINTESTINAL SYSTEM BLOCK

CASE 5A

Ronald Chrisbianto Gani 405090223 Faculty of Medicine 2009 Tarumanagara University

IRRITABLE BOWEL SYNDROME (IBS)

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities Male : Female = 1 : 3 Prevalence 3,6 21,8 % (~11%) Unknown etiology, but considered as multifactorial May happen as diarrhea predominance, constipation predominance, or post-infectious
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DIAGNOSTIC CRITERIA
ROME III CRITERIA

MANNING CRITERIA
Frequent clinical symptoms of IBS
Liquid stool when pain occurs Increased defecation frequency when pain Pain decreased after defecation Abdominal distention

Additional symptoms of IBS

Mucus in stool Unfinished feeling on defecation Buku Ajar Ilmu Penyakit Dalam Edisi V Jilid I

DIAGNOSIS
CBC (Complete Blood Count) Blood Biochemistry Test Liver function test Tyroid hormone (on chronic diarrhea) Colonoscopy and biopsy to distinguish microscopic colitis

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DIAGNOSIS
SUBGROUP IBS
Abdominal Pain predominance
Pain in the fossa iliaca, diffuse More than 6 month Pain reduced after defecation Pain increased when in emotional stress and menstruation Persistent pain and more severe when relaps

Constipation Predominance
Mostly in women Feces with mucus Incomplete sensation

Alternating pattern
Interchanging pattern of diarrhea and constipation Hard stool in the morning followed by several defecation and liquid stool in the afternoon

Diarrhea Predominance
Diarrhea in the morning, often with urgency Acccompanied by pain and decreased after defecation

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IBS Severity

Harrisons Principle of Medicine 17th ed Vol I

DIFFERENTIAL DIAGNOSIS
Lactase deficiency Colorectal Cancer IBD Mechanical Obstruction Bowel Infection Ischemia Maldigestion Malabsorbtion Endometriosis Diverticulitis

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MANAGEMENT
Diet
Fiber consumption. (+) in constipation, (-) in diarrhea Water consumption Routine exercise Avoid triggering food / drinks, common triggers : wheat, caffeine, onion, chocolate, some vegetable

Psychological intervention
Explanation about IBS that IBS is curable, not life threathening and the importance of lifestyle Controlling the emotional stress and not overwork Maintain routine defecation Eating not in rush and routine exercise Buku Ajar Ilmu Penyakit Dalam
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MANAGEMENT
Pharmacological Therapy

Harrisons Principle of Medicine 17th ed Vol I

Harrisons Principle of Medicine 17th ed Vol I

PROGNOSIS
Do not cause death The symptoms will reduced and diminished in 12 month in 50% cases Only 5% get worse and the rest is settled

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