IBS checklist‫ﻣﺘﻼزﻣﺔ اﻻﻣﻌﺎء اﻟﻤﻀﻄﺮﺑﺔ‬

Abdominal pain

Rome 3 criteria :
Recurrent abdominal pain at least 1 day/week in the past 3 months
associated with 2 or more of the following
Improvement with defecation; and/or

Onset associated with a change in frequency of stool; and/or

Onset associated with a change in form (appearance) of stool

Checklist
§ Greeting / introduce your self
§ Establish a rapport
§ Patient ID
§ Chef complain analysis:
Site , character , onset , duration , severity , radiation , aggravating
,relieving factors
Affecting her sleep and life?
Previous episodes?
§ Red flags:
Weight loss,fever , night sweat , hematemesis , melena , hematochezia ,
excessive vomiting , dysphagia , odynophagia , family hx of cancers.
§ Associated symptoms:
IBS : relieved with defecation , associated with change in frequency ,
associated with change in stool form , altered bowl motions , mucus with
stool, incomplete evacuation.
IBD: hematochezia , joint pain , red eye , skin changes.
Dyspepsia :early satiety ,postprandial fullness.
GERD: regurgitation , halitosis.
Cholecystitis : increase with fatty meals
Hepatitis: jaundice , change in urine or stool color , hx of iv use and travel
Gyne: pv bleeding , dyspareunia , vaginal discharge
Urology: dysuria
Depression : low mood , loss of interest
 § Past medical
§ Past surgical
§ Previous visits or procedure ( EGD )
§ Medications
§ Family hx : IBD , IBS , Malignancies
§ Allergy hx
§ Social : smoking , alcohol , stress , job
§ Summery
§ ICEE

Physical examination:
§ BMI
§ Vitals
§ General examination ( nail changes , pallor , scratch marks , jaundice ,
spider nevie)
§ Abdominal examination

Interactions: (Explain to the patient)

From your history and examination what you most probably complain of is IBS .
it’s a chronic common complain. No known causes yet .
Usually it is alternating constipation and diarrhea with associated abdominal pain

Investigation:
(CBC , Renal profile , electrolyte , LFT , tissue transglutaminase , ESR , CRP h pylori
antigen, stool ova and parasite)
abdominal ct for masses
abdomen US for gyne or cholecystitis.
Endoscopy for GERD or red flags
No labs or radiology needed to diagnose IBS
Management:

1. Life style : exercise , relaxing , avoid stressors

2. Diet : avoid food that triggers your symptoms ( spicy , diary , caffeine
legumes..)
Eat regular meal and adequate fluid intake .
3. Medications:
Constipations :
Laxatives ( lactulose , polyethylene glycol , new medication :lubiprostone ,
linaclotide)
Diarrhea :
Anti diarrheal ( loperamide, new medication alosetron)
Abdominal pain : hyoscine , mebeverine and semithicone .
4. Psychological : CPT , TCA , SSRI

Follow up
Referral : to gastroenterology if needed for further investigations or red flags
Safety netting
Opportunistic health promotions ( screening , vaccination , education )
Do you have any question?

Done by : Maysaa Ageel