Irritable Bowel Syndrome

May Ann Valledor Click to edit Master subtitle style NCM 103

4/1/12

Irritable Bowel Syndrome (IBS)

Condition marked by abdominal pain (often

relieved by passage of stool or gas), disturbances of evacuation (constipation, diarrhea, or alternating episodes of both), bloating and abdominal distension, and passage of mucus in stools.

4/1/12

Etiology
The causes of irritable bowel syndrome

remain poorly defined, but they are being avidly researched.

The most current research on the topic

suggests a biopsychosocial model of the disorder, implicating physiological, emotional, behavioral and cognitive factors
4/1/12 Other possible causes: Infection, Altered

Psychosocial Factors Anxiety or Depression

Altered Motility Distension Spasm Neurotransmitter Imbalance Seratonin Inflammation and Infection Enteric or neural plexuses

Risk Factors: Heredity Psychologi cal Stress Depression and Anxiety Diet high in fat and stimulating

Visceral Hypersensitivity Pain Bloating Urge to Deficate

4/1/12

Signs and Symptoms of IBS

Classic Clinical Findings:

Abdominal Pain Constipation Diarrhea Flatus Abdominal Distension
4/1/12

4/1/12

Medical and Surgical Management

IBS is generally diagnosed on the basis of a

complete medical history that includes a careful description of symptoms and a physical examination.

To facilitate comparisons among different

populations and assist and epidemiological studies of IBS, two sets of criteria for diagnosis have been developed.
The Manning and Rome II Criteria
4/1/12

Manning and Rome Criteria

4/1/12

Diagnostics
CBC Chemistry Panel Erythrocyte sedimentation rate
Also called sedimentation rate or Biernacki

Reaction

Non-specific measure for inflammation

Stool test for fecal occult blood Colonoscopy in patients 50< (a family

history of colon cancer may warrant an earlier test)

4/1/12

Medical and Surgical Management

Dietary Measures
Fiber supplements or laxatives improve

symptoms of constipation and diarrhea

Increase water intake Caffeine avoidance Gluten intolerance

Psychological Therapy
IBS patients most frequently present with

depression and anxiety.

4/1/12

Cognitive Behavioral Therapy (CBT) for

Drug Therapy
Smooth Muscle Relaxants anticholinergic

and antispasmodic ; (dicyclomine, hyocyamine, clidinium) to 4 times a day)

Antidirrheal agents (loperamide 2-4 mg up Psychotropic agents (Amitriptyline 10-

25mg daily; imipramine 25-50mg daily) (paroxetine, fluoxetine and sertraline; Zoloft and Effexor for older patients associated with fewer anticholinergic side 4/1/12 effects)

Selective Serotonin Reuptake Inhibitors

4/1/12

Nursing Management
Monitor hydration, intake and output Encourage Pt to eat small meals at regular

intervals per day

Encourage fluids; goal is 8 glasses of water Encourage frequent ambulation Encourage necessary lifestyle changes to

promote stress reduction

Encourage regular exercise Suggest Pt get adequate sleep and avoid

becoming fatigued

4/1/12

Avoid foods and beverages identified as