IBS KMP(1)(1).pptx - Irritable Bowel Syndrome Family Nurse Practitioner GI Disorders Pendergrass Introduction Common functional GI disorder Idiopathic

IBS KMP(1)(1).pptx - Irritable Bowel Syndrome Family Nurse...

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Irritable Bowel Syndrome Family Nurse Practitioner: GI Disorders Pendergrass
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Introduction Common functional GI disorder Idiopathic cause; no cure Chronic condition w/ severe impact on qol Abdominal pain/discomfort; altered bowel habits No specific tests; symptoms vary & can be contradictory (constipation alt w/ diarrhea) Most IBS treated at primary care level 2
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Epidemiology 25-45 million people in US; roughly 10-15% of population 3.5 million primary care visits yearly Most common in young adults 18-34; 50% of cases appear before age 35 10% has onset after age 60 (so must be considered in elderly with abdominal pain, diarrhea, constipation More prominent in women (65%). Tends to run in families 3
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Common Comorbidities: NonGI somatic disorders Chronic pelvic pain Fibromyalgia Chronic fatigue Dysmenorrhea Cystitis 4
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Common Comorbidities: GI Disorders Diverticulosis Gastritis GERD PUD IBD Family history of IBD, colon ca and celiac disease are risk factors 5
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Comorbid Psychiatric Disorders Comorbid Psychiatric disorders affect 50% of IBS patients: Anxiety Depression Higher level of lifetime & daily stress 44% experienced physical or sexual abuse in childhood 7
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Etiology Not fully defined Hypotheses range from purely psychosocial to post-infectious alteration of GI tract generally seen as a biopsychosocial disorder 8
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Wide range of Factors that can have impact on IBS symptoms Psychological—stress, trauma, abuse Dietary—artificial sweeteners, fructose, sorbitol Medications—hydroxychloroquine, orlistat, antidepressants, hyperlipidemia agents, narcotics Neuromuscular disorders—Parkinson's disease, multiple sclerosis, cerebral palsy Pelvic floor dysfunction—post-gynecologic surgery, cystocele, rectocele Post-acne—isotretinoin, tetracycline, minocycline Post-cholecystectomy 9
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At least 3 interrelated factors IBS is not characterized by any specific physiologic mechanism. 1. Altered gut reactivity in response to luminal or provocative environmental stimuli, resulting in symptoms of diarrhea and/or constipation 2. Hypersensitive gut with enhanced visceral perception and pain 3. Dysregulation of the brain-gut axis, possibly associated with greater stress-reactivity and altered perception and/or modulation of visceral afferent signals. 10
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Psychosocial issues play important role in development of IBS Stress may exacerbate symptoms & may increase health care seeking behavior Traumatic life events are correlated with IBS Chronic stress may impair resolution of symptoms Bacterial infection has recently been recognized as important cause of IBS Campylobacter jejuni , Salmonella enteritidis , and Shigella flexneri 11
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Diagnosis ¾ remain undiagnosed Accurate diagnosis is challenge 3 subtypes based on stool-habit alteration: constipation-predominant diarrhea-predominant pain-predominant, also known as IBS with alternating diarrhea-constipation.
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