_bowel syndrome didacticsonline肠易激综合征 课件

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1、IrritableBowelSyndromeByTaraNowakhtarDidacticsOnline.comCasePresentation24yearoldfemalepresentswiththefollowingsymptomsCrampyfeeling(abdominalpain),varyingintensity,intermittentStressandeatingexacerbatepainBowelmovementrelievespainAlternatingdiarrhea&constipationBloated/gassyfeelingGastroesophag

2、ealreflux(“heartburn”)Dyspareunia,fatigueCase:Pthashadthesesymptomsforseveraldaysamonthinthelast6monthsPMHx:depression,anxietySHx:appendectomyPE:Abdomentendertopalpationinall4quadrantswithsignificantguardingAbdomensoundstympaniconpercussionGlobalfascialtightnessthroughoutabdomenParaspinalchanges

3、atT9-T10EpidemiologyofIBSIBSisanintrinsiccolonicmotilitydisorderwithseveralplausiblecauses:lossoftolerancetoGIflora,geneticfactors,environmentaltriggersMCfunctionalboweldisorderF>>MRiskfactors:HxofchildhoodsexualabuseDomesticabuseinwomenIncreasedstress,depression,anxietyPathophysiologyofIBSNopat

4、hognomonicpatternofgutdysmotilitycanbeidentifiedwithIBS,unlikeotherfunctionalgutdisorders;however,itissuggestedthatamotilitydisturbanceistheunderlyingissueinIBSpatientsIncreasedsensitivityinthevisceraiscommonlyfoundinIBSpatientsDistention-Awarenessandpaincausedbyballoondistentioninintestineareex

5、periencedatlowervolumethanwithcontrolsBloating–studieshaveshownthatalthoughtherearesimilaramountsofgasinIBSvs.controlpatients,thereisimpairedtransitofthatintestinalgasPathophys….IntestinalInflammation–mucosalimmuneactivationhasbeenshowninIBS,characterizedbyalterationsinimmunecellsandmarkers;most

6、lyindiarrheapredominantLymphocytes–increasednumbersreportedincolonandSIinhemyentericplexusMastcells–interminalileum,jejunum,colon;somestudieshaveshowedacorrelationbetweenabdominalpainandthepresenceofactivatedmastcellsaroundcolonicnervesPathophys….PostinfectiousIBS–thishasbeensuspectedbaseduponah

7、istoryofacutediarrhealillnessprecedingonsetofIBSsymptomsinsomepatientsSigns&SymptomsGIsymptoms:Chronicabdominalpain(crampy,variableintensity)Emotionalstressandeatingpain,defecationpainAlteredbowelhabitsOtherGIsymptoms:GEre