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Irritable Bowel Syndrome

Irritable Bowel Syndrome. Chiefly a motility disorder Pain / cramps often relieved with BM Chronic constipation, chronic diarrhea, or some combination, with change in stool appearance Cause(s) Treatments : anti-spasmodics, anti-diarrheals, anti-constipation agents, SSRIs, reassurance.

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Irritable Bowel Syndrome

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  1. Irritable Bowel Syndrome • Chiefly a motility disorder • Pain / cramps often relieved with BM • Chronic constipation, chronic diarrhea, or some combination, with change in stool appearance • Cause(s) • Treatments: anti-spasmodics, anti-diarrheals, anti-constipation agents, SSRIs, reassurance

  2. Diverticular Disease • Fairly common in those over 60 • Due to fiber-deficient diet • Diverticulosis • Diverticulitis

  3. Appendicitis • Signs • Iliopsoas and obturator signs • Rovsing’s sign • McBurney’s sign • Cutaneous hyperesthesia • Periumbilical pain, migrates • N / V, anorexia, obstipation, fever • Tx: surgical. Complicated with perforation

  4. Gallbladder disease • Cholecystitis • Female, fat, forty, flatulent, fertile • Tx: medical, surgical • Cholelithiasis • Cancer / Tumor • Gallstone pancreatitis • Biliary tract obstruction

  5. Hepatitis • N / V, anorexia, malaise, fever, jaundice • Causes: viral, EtOH, drugs, autoimmune, toxins • Exam: check for liver tenderness, hepatomegaly, caput medusa • Tx: remove offending agent, tx viral types if possible

  6. Inflammatory Bowel Diseases • Crohn’s disease • Bouts of fever, RLQ pain, diarrhea • Perianal abscess, fistulas • Extra-colonic manifestations • Tx: diet, 5-ASA, steroids, anti-TNF drugs • Ulcerative colitis • Bloody diarrhea, fecal urgency • Tx: 5-ASA, steroids, surgery • Increased risk of colon CA

  7. Ulcers • Gastric – usually worse with intake • Duodenal – often relieved with intake

  8. Gastritis • Usually benign and self-limiting with proper approach • Nausea, vomiting, cramping, fever • Caused by GI irritants, infection, stress • Tx: clear fluids for 24-48 hrs, then BRAT

  9. Pancreatitis • EtOH abuse # 1 cause • Also due to large fatty meals • Exam: Cullen’s sign, tender LUQ • Tx: IV fluids, NPO

  10. GERD • EtOH, chocolate, tobacco, caffeine, mint, tomato sauce/salsa, lying flat • Problem with LES • Often abdominal obesity, poor eating habits • Sour brash, retrosternal pain, cough, voice changes • Tx: H2 blockers, PPIs, diet changes, wt loss

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