"لعلي أفيدك" Clinical discussion

2021-10-17 21:24:05 all about internal medicine updates in all branches and Git Endoscopy
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2021-10-17 19:42:39 يسعد مساكم
#GIT_43 #IBS

في البوستات السابقه عرَّفنا ال IBS وعرفنا انه عباره Chronic Abdomonal pain بيكون معه تغير بال Bowel Habit بدون وجود أي Organic Dysfunction
وقسمنا ال IBS ل Subtype على حسب ال Predominant symptoms ف وارد يكون ال IBS معه diarrhea وبنسميه IBS-D
او Constipation وبنسميه IBS-C
او mixed مرات Diarrhea ومرات Constipation فبنسميه IBS-M
او يكون (Unclassified (IBS-U


وكان أدق تعريف حسب ال ROME4 Criteria

●Irritable bowel syndrome (IBS) – Irritable bowel syndrome is defined as recurrent abdominal pain on average, at least one day per week in the last three months with two or more of the following: related to defecation, associated with a change in frequency of stool, or associated with a change in form (appearance) of stool

واتفقنا انه وجود اي Alarm symptoms بيلزم المريض Further Evaluation لاستبعاد ال Other GI disease ..
حنكمل مع اخر جزء بال IBS



Treatment of IBS

In patients with mild and intermittent symptoms that do not impair quality of life, we initially recommend lifestyle and dietary modification alone rather than specific pharmacologic agents.

In patients with mild to moderate symptoms who fail to respond to initial management and in patients with moderate to severe symptoms that affect quality of life, we suggest pharmacologic therapy as adjunctive treatment



من اهم ال Dietary modifications اللي بننصح فيها المريض :

Patients with IBS may benefit from exclusion of gas-producing foods; a diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs); and in select cases, lactose avoidance as in Lacose Intolerance Pateint ...
( ال Diet اللي بتحتوي على ال FODMAPs مرفقه مع الصور)

لو كان ال Life style modifications غير كافي والمريض متحسنش ساعتها بندخل على ال Pharmacological Option

treatment should be based on the predominant symptom and subtype.
علاج ال IBS بيعتمد على النوع ...


IBS-C management ..

علاج ال Constipation لمريض ال IBS-C

بنبدأ ب polyethylene glycol (PEG) , ولو ما استجاب المريض
بيتشفت على
lubiprostone, linaclotide, or plecanatide

واخر Choise هو ال tegaserod ل Short term

PEG ( Osmatic Laxative )

initially start with 17 g of powder dissolved in 8 ounces of water once daily and titrate up or down (to a maximum of 34 g daily) to effect. However, side effects of bloating and abdominal discomfort limit the use of PEG.
مشكله ال PEG انها بتزود ال
&Flatulenceabdominal distention
وما بتحسن الIBS Symptom

lubiprostone
Lubiprostone is used for treatment of IBS-C in women 18 years and older
الميكانزم لل lubiprostone انه بيفتح chloride Channel
فبيزود ال Water Influx داخل ال Lumen
جرعته
Females ≥18 years: Oral: 8 mcg twice daily
وبتتعدل جرعته لو في Hepatic Impairment ..

Linaclotide ( 290 micrograms daily) / plecanatide (3 mg once daily)

are guanylate cyclase agonists that stimulates intestinal fluid secretion and transit.

their role in the treatment of IBS-C is limited to patients with persistent constipation despite treatment with PEG
ممنوع استخدامهم للي اقل من 18 سنه ...

5-hydroxytryptamine (serotonin) 4 receptor agonists : tegaserod
ال Tegaserod بيحسن ال Abdominal pain وبيقلل ال Constipation وال Dyspepsia
لكنه لا يستخدم الا في حالات ال Emergency IBS ول Short term لانه اله CVS SE

A history of ischemic colitis, intestinal ischemia, bowel obstruction or adhesions, symptomatic gallbladder disease, and suspected Sphincter of Oddi dysfunction are some of the contraindications to the use of tegaserod.

Sodium/hydrogen exchanger 3 (NHE3) inhibitor (Tenapanor)

a sodium/hydrogen exchanger 3 reduces the absorption of sodium and phosphate and enhances intestinal fluid volume and transit

Dose : 50 mg twice daily.

Diarrhea, abdominal distension, flatulence and dizziness were the most frequent side effect
نوقف لحد هنا والبوست القادم رح نكمل مع باقي الادويه اللي بتستخدم لعلاج ال IBS
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2021-10-15 21:51:34 باز کردن / نظر دهید

2021-10-15 21:50:03 جمعه مباركه
#GIT_42_IBS

كنا بدأنا بال Irritable Bowel Syndrom وعرفنا انها Subtype حسب شو ال هو ال Predominant symptom
ففي عنا IBS-D وفي IBS-C وفي IBS-M وفي IBS-U

اليوم ان شاء الله رح نكمل مع ال Criteria اللي بنستخدمها لتشخيص ال IBS ...



Irritable bowel syndrome (IBS) should be suspected in patients with chronic abdominal pain and altered bowel habits (constipation and/or diarrhea)

تشخيص ال IBS بيعتمد على ال
Excluding to other GI Disease + Perform ROME4 Criteria

مثلا لو مريض عنده Diarrhea بنستبعد ال IBD وال Celiac disease ...
In patients with diarrhea, we perform the following

•Fecal calprotectin or fecal lactoferrin
لاستبعاد ال IBD
•Stool testing for giardia (antigen detection or nucleic acid amplification assay)

•Serologic testing for celiac disease

•C-reactive protein levels, only if fecal calprotectin and fecal lactoferrin cannot be performed

وبنستبعد اي ادوية بتعمل Diarrhea او Constipation
( الادويه اللي بتاثر ع ال GI Motality مرفقه بالصور )



طيب شو هي ال Diagnostic criteria اللي بتستخدم لتشخيص ال IBS
في عنا كذا Criteria زي ال Kruis وال manning وال Rome IV criteria

الاشهر والاكثر استخداما هي ال ROME4

According to the Rome IV criteria, IBS is defined as recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following criteria :

•Related to defecation

•Associated with a change in stool frequency

•Associated with a change in stool form (appearance)

يبقى لو المريض عنده Reccurent Abdominal pain مره اسبوعيا على الاقل خلال اخر 3 شهور مع نقطتين من النقاط السابقه بدون وجود أي Alarm Symptom فبيتشخص IBS

اما لو المريض عنده Alarm symptom فبيحتاج Further Evaluation

Alarm Symptoms

•Age of onset after age 50 years

•Rectal bleeding or melena

•Nocturnal diarrhea

•Progressive abdominal pain

•Unexplained weight loss

•Laboratory abnormalities (iron deficiency anemia, elevated C-reactive protein or fecal calprotectin/lactoferrin)

•Family history of IBD or colorectal cancer

نوقف لحد هنا والبوست القادم رح نكمل ان شاء الله مع ال Ttt
#لعلي_أفيدك باز کردن / نظر دهید

2021-10-14 23:22:17 باز کردن / نظر دهید

2021-10-14 23:22:01 -تبقى عشريني مكتئب وبائس واللي فيك مكفيك... القولون يسكت؟
=لا بص بقولك ايه أنا هكتئب معاك

#القولون_العصبي
#GIT_41 #Irritable_Bowel_Syndrome (#IBS)

ال IBS عباره عن Syndrom فيها كذا Symptom و بيعتبر من ال Functional GI Disorder ف هو خلل وظيفي بال GI
وحاليا بيسموه Disorder of GUT Brain Interaction

ف ال CNS بيبعت اشارات لل GUT وعبر neurotransmitters زي ال Serotonin وغيره بيغير بال GI motality وبيعمل Visceral Hypersensitivity ....

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits in the absence of an organic disease

ف شكوة المريض حتكون Chronic Abdominal pain مع تغيير بال bowel habits
وبناء على ال Bowel habit ال IBS بيتقسم ل Subtype بالاستعانه بال
Bristol stool form scale (BSFS) to record stool consistency

IBS-D
بيكون ال predominant هو ال Diarrhea

Diarrhea — Diarrhea is usually characterized as frequent loose stools of small to moderate volume. Bowel movements generally occur during waking hours, most often in the morning or after meals. Most bowel movements are preceded by lower abdominal cramping pain, urgency, and a sensation of incomplete evacuation or tenesmus. Approximately one-half of all patients with IBS complain of mucus discharge with stools
Large volume diarrhea, bloody stools, nocturnal diarrhea, and greasy stools are not associated with IBS.

IBS-C
ال predominant هو ال Constipation

Constipation — Stools are often hard and may be described as pellet-shaped. Patients may also experience tenesmus even when the rectum is empty.

IBS-M
بيكون في mix بين ال Constipation & Diarrhea

IBS-U Unclassified



تشخيص ال IBS باختصار بيكون عباره عن Role out لامراض ال GI

A clinical diagnosis of IBS requires the fulfillment of symptom-based diagnostic criteria and a limited evaluation to exclude underlying organic disease

ولل Diagnoses بنستخدم ROME 4 Criteria زي ما حنشوفها ان شاء الله البوست القادم
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