Tuesday, March 9, 2010

Irritable bowel syndrome

Irritable bowel syndrome - Chronic


 

Definition  

A common functional, chronic, and episodic gastrointestinal disorder which primarily affects motility of the gut , and is characterized by abdominal pain, discomfort, and defecation disturbances.


 

Medical History  

* Bacterial gastroenteritis

* Drug therapy finding

* Family history of Irritable bowel syndrome

* Food intolerance

* Psychological finding

* Victim of abuse

* Stress


 

Findings  

* Abdominal distension

* Abdominal pain

* Altered appetite

* Altered bowel function

* Finding related to ability to defecate

* Flatulence

* Heartburn

* Indigestion - Chronic

* Lethargy

* Mucus in stool

* Psychological finding


 

Tests  


 

Suspected irritable bowel syndrome (IBS)  

* Complete blood count: CBC in irritable bowel syndrome is normal .


 

Differential Diagnosis  

* Colon cancer

* Gastrointestinal obstruction

* Inflammatory bowel disease - Chronic

* Rectal prolapse

* Celiac disease - Chronic

* Intestinal infectious disease

* Finding relating to psychosocial functioning

* Lactose intolerance - Chronic

* Hypothyroidism - Chronic

* Hyperthyroidism - Chronic

* Intestinal malabsorption of fat


 

Treatment  


 

Drug Therapy  


 

Irritable bowel syndrome with abdominal pain  


 

AMITRIPTYLINE HYDROCHLORIDE  

Adults: Initial dose 10 to 25 mg orally at bedtime; titrate to maintenance dose 10 to 100 mg orally at bedtime


 

DESIPRAMINE HYDROCHLORIDE  

Adults: Initial dose 10 to 50 mg orally at bedtime; titrate to maintenance dose 10 to 150 mg at bedtime


 

IMIPRAMINE HYDROCHLORIDE  


 


 

HYOSCYAMINE  

Adults: 0.125 to 0.25 mg orally every 4 hours (maximum, 1.5 mg per day)


 

DICYCLOMINE HYDROCHLORIDE  

Adults: Initial dose 20 mg orally four times daily; maintenance dose 20 to 40 mg orally four times daily; discontinue if ineffective after 2 weeks


 


 

Irritable bowel syndrome with chronic diarrhea  


 

LOPERAMIDE HYDROCHLORIDE  

Adults: Initial dose 4 mg orally; then maintenance dose 4 to 8 mg orally per day

Pediatrics: dose not established, but 0.08 to 0.24 mg/kg per day in 2 to 3 divided doses has been used


 

Irritable bowel syndrome with constipation  


 

POLYETHYLENE GLYCOL 3350  

Adults: 17 g (about one heaping tablespoon) orally per day dissolved in 4 to 8 ounces of water, juice, soda, coffee, or tea


 

BISACODYL  

Adults: 5 to 15 mg orally once daily (maximum, 30 mg/day) OR 10 mg suppository rectally once daily; use for more than 7 days is not recommended

Pediatrics (6 to 11 yrs): 5 mg orally once daily OR 5 mg suppository rectally once daily; use for more than 7 days is not recommended


 

PSYLLIUM HYDROPHILIC MUCILLOID  


 


 

METHYLCELLULOSE  


 


 

CALCIUM POLYCARBOPHIL  


 

Irritable bowel syndrome with psychosocial disturbance  


 

PAROXETINE HYDROCHLORIDE  


 


 

FLUOXETINE HYDROCHLORIDE  


 


 

Procedural Therapy  


 

Suspected and known irritable bowel syndrome with psychological symptoms  

* Cognitive - behavior therapy: Cognitive behavioral therapy may improve some individual symptoms associated with irritable bowel syndrome (IBS) .


 

Non-Procedural Therapy  


 

Irritable bowel syndrome  

* Symptom Diary


 

 
 

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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence