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Irritable Bowel Syndrome - IBS
Irritable Bowel Syndrome - IBS
Irritable Bowel Syndrome - IBS
CASE 5A
DIAGNOSTIC CRITERIA
ROME III CRITERIA
MANNING CRITERIA
Frequent clinical symptoms of IBS
Liquid stool when pain occurs Increased defecation frequency when pain Pain decreased after defecation Abdominal distention
DIAGNOSIS
CBC (Complete Blood Count) Blood Biochemistry Test Liver function test Tyroid hormone (on chronic diarrhea) Colonoscopy and biopsy to distinguish microscopic colitis
DIAGNOSIS
SUBGROUP IBS
Abdominal Pain predominance
Pain in the fossa iliaca, diffuse More than 6 month Pain reduced after defecation Pain increased when in emotional stress and menstruation Persistent pain and more severe when relaps
Constipation Predominance
Mostly in women Feces with mucus Incomplete sensation
Alternating pattern
Interchanging pattern of diarrhea and constipation Hard stool in the morning followed by several defecation and liquid stool in the afternoon
Diarrhea Predominance
Diarrhea in the morning, often with urgency Acccompanied by pain and decreased after defecation
IBS Severity
DIFFERENTIAL DIAGNOSIS
Lactase deficiency Colorectal Cancer IBD Mechanical Obstruction Bowel Infection Ischemia Maldigestion Malabsorbtion Endometriosis Diverticulitis
MANAGEMENT
Diet
Fiber consumption. (+) in constipation, (-) in diarrhea Water consumption Routine exercise Avoid triggering food / drinks, common triggers : wheat, caffeine, onion, chocolate, some vegetable
Psychological intervention
Explanation about IBS that IBS is curable, not life threathening and the importance of lifestyle Controlling the emotional stress and not overwork Maintain routine defecation Eating not in rush and routine exercise Buku Ajar Ilmu Penyakit Dalam
Edisi V Jilid I
MANAGEMENT
Pharmacological Therapy
PROGNOSIS
Do not cause death The symptoms will reduced and diminished in 12 month in 50% cases Only 5% get worse and the rest is settled