_bowel syndrome university of pittsburgh肠易激综合征匹兹堡大学课件

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1、IrritableBowelSyndromeDrBruceDavieswww.bradfordvts.co.ukIntroductionFirstdescribedin1771.50%ofpatientspresent<35yearsold.70%ofsufferersaresymptomfreeafter5years.GPswilldiagnoseonenewcaseperweek.GPswillsee4-5patientsaweekwithIBS.Pointprevalenceof40-50patientsper2000pa

2、tients.Sept20012BruceDaviesWhatIsIBS?Asyndrome.Oneman’sconstipationisanotherman’snormality.Causeunknown.20%seemtostartafteranepisodeofgastroenteritis.Sept20013BruceDaviesDiagnosticCriteriaRome11Diagnosticcriteria.Manning’sCriteria.Sept20014BruceDaviesRome11Diagnostic

3、Criteria.Atleast12weekshistory,whichneednotbeconsecutiveinthelast12monthsofabdominaldiscomfortorpainthathas2ormoreofthefollowing:Relievedbydefecation.Onsetassociatedwithchangeinstoolfrequency.Onsetassociatedwithchangeinformofthestool.Sept20015BruceDaviesRome11Diagnos

4、ticCriteria.Supportivesymptoms.Constipationpredominant:oneormoreof:BOlessthan3timesaweek.Hardorlumpystools.Strainingduringabowelmovement.Diarrhoeapredominant:oneormoreof:Morethan3bowelmovementsperday.Loose[mushy]orwaterystools.Urgency.Sept20016BruceDaviesRome11Diagno

5、sticCriteria.General:Feelingofincompleteevacuation.Passingmucusperrectum.Abdominalfullness,bloatingorswelling.Sept20017BruceDaviesManning’sCriteria.Threeormorefeaturesshouldhavebeenpresentforatleast6months:Painrelievedbydefecation.Painonsetassociatedwithmorefrequents

6、tools.Looserstoolswithpainonset.Abdominaldistension.Mucusinthestool.Afeelingofincompleteevacuationafterdefecation.Sept20018BruceDaviesAssociatedSymptomsInpeoplewithIBSinhospitalOPD.25%havedepression.25%haveanxiety.PatientswithIBSsymptomswhodonotconsultdoctors[populat

7、ionsurveys]haveidenticalpsychologicalhealthtogeneralpopulation.Inonestudy70%ofwomenIBSsufferershavedyspareunia.Sept20019BruceDaviesAssociatedSymptomsStressfullifeeventsareassociated.ComparedwithcontrolspeoplewithIBSarelesswelleducatedandhavepoorergeneralhealth.Women:

8、Men=3:1.Sept200110BruceDaviesReasonstoReferAge>45yearsatonset.Familyhistoryofbowelcancer.Failureofprimarycaremanagement.Uncertainty