IRRITABLE
BOWEL
SYNDROME
Irritable bowel syndrome (IBS) is a
chronic functional disorder
characterized by recurrent
abdominal pain associated with
disordered bowel movements, which
may include diarrhea, constipation, or
both, without an identifiable cause
It is believed that some triggers can
either herald the initial onset of IBS or
exacerbate symptoms in those with
diagnosed IBS; these may include
chronic stress, sleep deprivation,
neurohormonal deregulation, bacterial
overgrowth, genetics, surgery,
infections (e.g. Giardia), inflammation,
and food intolerance (Pacheco et al.,
2019).
CAUSES OF IBS
1. Abnormal Gastrointestinal tract
movements
2. A change in the nervous system
communication between the GI and
the brain
3. Sensory and motor disorders of
the colon
4. Dietary allergies or food
sensitivities
5. Neurotransmitter imbalance
(decreased serotonin levels)
6. Stress
RISK FACTORS
Emotional stress or anxiety,
depression
Diverticulitis
Intolerance to gastric
stimulants such as caffeine or
spicy foods or lactse
Diet high in fats
Smoking and alcohol
Cause: UNKNOWN
TYPES OF IBS
IBS-C (constipation)
the person tends to alternate
constipation with normal stools
IBS-D (diarrhea)
The person tends to experience
diarrhe first thing in the
morning or after eating
IBS-M (mixed)
HYSIOLOGY
PATHOP
IBS results from a functional disorder of intestinal
motility. The change in motility may be related to
neuroendocrine dysregulation, especially changes in
serotonin signaling, infection, irritation, or a vascular
or metabolic disturbance. The peristaltic waves are
affected at specific segments of the intestine and in
the intensity with which they propel the fecal matter
forward. There is no evidence of inflammation or
tissue changes in the intestinal mucosa (Norris, 2019).
Abdomina cramps
(releieved by
Emotional Constipation defecation)
stress Alteration in
Bloating
Anxiety gastric
Anorexia
Diverticulitis motility Diarrhea Fatigue
Stimulants
Headache
DIAGNOSTIC TEST
Contrast studies
barium enema
Colonoscopy
Manometry and
electromyography
flexible sigmoidoscopy
CT scan
Lactose intolerance test
INTERVENTION
NURSING
Administer anti-diarrheals, antispamodics, bulk-forming laxatives
as ordered
Encourage high- fiber diet and avoid fatty and gas forming foods
Instruct client to avoid tobacco
Encourage to increase oral fluids intake but should not be take
with meals because it can result to distention
Instruct with meals because it can result to distention
Instruct on lifestyle changes
ANticholinergics and Ca Channel blocker
ASSES SM EN T AN D
OS TIC FIN D IN GS
DIAGN
The Rome IV criteria define IBS as recurrent abdominal pain occurring at
least once daily during the last 3 months, associated with two or more of
the following:
Abdominal pain related to defecation;
Abdominal pain associated with a change in frequency of stool;
Abdominal pain associated with a change in form/appearance of stool.
Recording the quality and quantity of bowel movements in a stool diary
such as the Bristol Stool Form Scale can be useful in determining the
category of IBS
L MANAGEMENT
MEDICA
The goals of treatment are to relieve abdominal pain and control
diarrhea or constipation. Lifestyle modification, including stress
reduction, ensuring adequate sleep, and
instituting an exercise regimen, can result in symptom improvement.
The introduction of soluble fiber (e.g., psyllium) to the diet is important
to IBS management. Restriction and then gradual reintroduction of
foods that are possibly irritating may help determine what types of
food are acting as irritants. Low-FODMAP diets, which restrict intake
of the following types of foods, might improve symptoms for some
patients (Pacheco et al., 2019)
L MANAGEMENT
MEDICA
Fermentable Oligosaccharides (e.g., wheat, rye, asparagus,
legumes, garlic, onions),
Disaccharides (lactose-containing foods such as milk,
yogurt),
Monosaccharides (fructose-containing foods such as
honey, agave nectar, figs, mangoes),
And Polyols (e.g., blackberries, lychee, and low-calorie
sweeteners)
INFLAMMATORY
BOWEL DISEASE
Inflammatory bowel disease (IBD) is a group of chronic
disorders: Crohn’s disease and ulcerative colitis that
result in inflammation or ulceration (or both) of the
bowel. Both disorders have striking similarities but also
several differences. Approximately 10% to 15% of
patients with IBD have characteristics of both
disorders and cannot be definitively diagnosed with
either disorder and are classified as having
indeterminate colitis (Rowe, 2020).
CROHN’S DISEASE
REGIONAL
ENTERITIS
Crohn’s disease, also called regional enteritis, is
characterized by a subacute and chronic inflammation of
the GI tract wall that extends through all layers (i.e.,
transmural lesion). Although its characteristic
histopathologic changes can occur anywhere in the GI
tract, it most commonly occurs in the distal ileum and the
ascending colon. Approximately 35% of patients have ileitis
(only ileal involvement); 45% have ileocolitis (diseased ileum
and colon); and 20% have granulomatous colitis (only colon
involvement) (Rowe, 2020).
HOPHYSIOLOGY
PAT
The inflammatory process in Crohn’s disease begins with crypt inflammation and
abscesses, which develop into small, focal ulcers. These initial lesions then deepen
into longitudinal and transverse ulcers, separated by edematous patches,
creating a characteristic cobblestone appearance in the affected bowel.
Fistulas, fissures, and abscesses form as the inflammation extends into the
peritoneum. Granulomas can occur in lymph nodes, the peritoneum, and through
the layers of the bowel in about half of patients. Diseased bowel segments are
sharply demarcated by adjoining areas of normal bowel tissue. These are called
skip lesions, from which the label regional enteritis is derived. As the disease
advances, the bowel wall thickens and becomes fibrotic, and the intestinal lumen
narrows. Diseased bowel loops sometimes adhere to other loops surrounding
them (Rowe, 2020).
TIVE COLITIS
ULCERA
Ulcerative colitis is a chronic ulcerative and
inflammatory disease of the mucosal and
submucosal layers of the colon and rectum that is
characterized by unpredictable periods of
remission and exacerbation with bouts of
abdominal cramps and bloody or purulent
diarrhea. The inflammatory changes typically begin
in the rectum and progress proximally through the
colon
HOPHYSIOLOGY
PAT
Ulcerative colitis affects the superficial mucosa of the colon and is
characterized by multiple ulcerations, diffuse inflammations, and
desquamation or shedding of the colonic epithelium. Bleeding occurs
as a result of the ulcerations. The mucosa becomes edematous and
inflamed. The lesions are contiguous, occurring one after the other.
Eventually, the bowel narrows, shortens, and thickens because of
muscular hypertrophy and fat deposits. Because the inflammatory
process is not transmural (i.e., it affects the inner lining only),
abscesses, fistulas, obstruction, and fissures are uncommon in
ulcerative colitis
inflammation of the intestinal mucosa
Ulceration surface epithelium Abscess formation
Poot absorption of vital nutrients
Stool containing blood and mucus
Thickening of the colon walll
Fibrosis and retraction of the bowel
DIA GNO STIC
FINDINGS
abdominal x-ray
Colonoscopy
Biopsies
CT scan
MRI
Ultrasound
fecal occult blood test
MANAGEMENT OF
INFLAMMATORY
BOWEL DISEASE
DRUG THERAPY
SALICYLATE COMPOUNDS
Sulfasalazine
Management of ulcerative colitis
Inhibits prostaglandin synthesis too
reduce inflammation
ADVERSE EFFECTS- leukopenia and
anemia
CLIENT INSTRUCTION- take glass
with a full glass of water
- take the drug after meals to
prevent GI discomfort
DRUG THERAPY
ORAL OR INTRAVENOUS
CORTICOSTEROIDS
Prednisone
To reduce inflammation
ADVERSE EFFECT- hyperglycemiia,
osteoporosis, peptic ulcer disease,
increased risk fo infection
DRUG THERAPY
IMMUNOSUPPRESSIVE DRUGS
Should be given in combination with
steroids to be effective
DRUGS: cyclosporine,
mercaptopurine
INDICATION: To reduce inflammation
ADVERSE EFFECTS:
thrombocytopenia, leukopenia,
anemia, renal failure, infection,
headache, stomatitis, hepatotoxicity
DRUG THERAPY
ANTI-DIARRHEAL DURGS
Diphenoxylate HCl and loperamide
INFLIXIMAB (REMICADE)
Given for refractory disease or forr
toxic megacolon an immunoglobulin
G hat neutralizes activity of tumor
necrosis factor
DIET THERAPY
if the client has severe symptoms:
NPO
TOTAL PARENTERAL NUTRITION (TPN)
AVOID
whole-wheat grains
nuts
fresh fruit and vegetables lactose
containing foodds caffeinated beverages
Pepper
Alcohol and smoking
SURGICAL
MANAGEM ENT
Indications for surgery
Bowel perforationn
Toxic megacolon
Hemorrhage
Colon cancer
Failure of conventional
treatment
SURGICAL
MANAGEM ENT
Patients with either ulcerative colitis or Crohn’s disease may require
surgery to relieve strictures. A common procedure performed for
strictures of the small bowel is laparoscope-guided strictureplasty, in
which blocked or narrowed sections of the intestines are widened,
leaving the intestines intact. In some cases, a small bowel resection is
performed; diseased segments of the small intestines are resected,
and the remaining portions of the intestines are anastomosed.
Surgical removal of up to 80% of the small bowel usually can be
tolerated
SURGICAL
MANAGEM ENT
Some patients with severe Crohn’s disease may
benefit from an intestinal transplant. This technique is
now available to children and to young and middle-
aged adults who have lost intestinal function from
disease. It may improve quality of life for some
patients.
