Presentation IBS & GERD


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Presentation IBS & GERD

  1. 1. Advanced Pathophysiology<br />N570/5270<br />
  2. 2. Irritable Bowel Syndrome<br />Gastro Esophageal Reflux Disease<br />
  3. 3. IBSIrritable Bowel Syndrome<br />Chaluza Kapaale RN, BSN<br />
  4. 4. Spastic colon, Irritable colon, Mucous colitis<br />Affects 10% to 15% of North American population<br />Not structural<br />Characterized by abdominal pain and cramping with alterations in bowel movements<br />More common in women ranging from teens to age 40<br />IBS typically co-exists with anxiety and depression<br />IRRITABLE BOWEL SYNDROME<br />
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  6. 6. The cause of IBS is not known but suggestions about the cause based on possible explanations of symptoms have been made.<br />What Causes IBS??<br />
  7. 7. Usually accompanied by distention of the rectum and other areas of the intestine. May be caused by disturbances in the brain gut-axis, serotonin, action of mast cells and T-lymphocytes, changes in autonomic and central nervous system function increasing perception of visceral pain.<br />Visceral hypersensitivity or hyperalgesia<br />
  8. 8. low grade inflammation and abnormal immune responses in intestinal tissue caused by intestinal infection have been linked to some IBS symptoms.<br />Post infectious IBS<br />
  9. 9. Overgrowth of bowel flora is often associated with IBS symptoms. Methane gas has been suggested to slow colonic transit times.<br />Intestinal flora overpopulation<br />
  10. 10. : Allergic reactions to consumed food increase mucosal hypersensitivity and IBS symptoms.<br />Foods such as chocolate, wheat, milk and alcohol are usually the culprits for these reactions. <br />Food allergy and food intolerance<br />
  11. 11. Influence brain – gut interactions, including neuro endocrine and pain modulation activities encouraging IBS symptoms.<br />Psychosocial factors:<br />
  12. 12. Those with diarrhea have fast colonic transit times and those with constipation have slower colon transit times. Changes most likely caused by visceral hypersensitivity or malfunction of the brain-gut axis and the role of serotonin in the enteric nervous system.<br />Abnormal motility and secretion<br />
  13. 13. As the name implies IBS affects the bowel.<br />Lower abdominal pain, diarrhea, constipation, or both diarrhea and constipation, gas, bloating and nausea. <br />Fecal urgency and incomplete evacuation.<br />Symptoms are usually relived by defecation.<br />Does not cause permanent damage to bowel and does not lead to adverse complications such as cancer.<br />TARGET SYSTEM<br />
  14. 14. IBS is often a life long condition that is usually disabling.<br />It affects life styles more than actual physical body systems by interfering with work, travel, socializing and other activities of daily living.<br />The main effect on the body is alterations in nutrition.<br />Typically does not affect sleep patterns<br />WHOLE BODY<br />
  15. 15. Based on signs and symptoms after ruling out structural and biochemical causes. Blood tests to rule out anemia and stool cultures to rule out infection. <br /> Celiac disease, colon cancer and inflammatory bowel disease are some causes of symptoms that must be ruled out. <br />Sigmoidoscopy and colonoscopy as needed may be used.<br />Diagnosis<br />
  16. 16. 3 months of continuous or recurring symptoms of abdominal pain or irritation that<br />May be relieved with a bowel movement,<br />May be coupled with a change in frequency, or<br />May be related to a change in the consistency of stools.<br />ROME III<br />
  17. 17. Two or more of the following are present at least 25 percent (one quarter) of the time:<br />A change in stool frequency (more than 3 bowel movement per day or fewer than 3 bowel movements per week) <br />Noticeable difference in stool form (hard, loose and watery stools or poorly formed stools) <br />Passage of mucous in stools<br />Bloating or feeling of abdominal distention<br />Altered stool passage (e.g. sensations of incomplete evacuation, straining, or urgency)<br />ROME III<br />
  18. 18. There is no cure, treatment addresses symptoms which vary among individuals.<br />Life style changes like avoiding foods and drinks that stimulate the intestine such as caffeine, soda or tea.<br />Smaller meals are better<br />Avoid wheat, chocolate, milk products and alcohol<br />Increase dietary fiber<br />Treatment<br />
  19. 19. GERDGastro Esophageal Reflux Disease<br />Chaluza Kapaale RN,BSN<br />
  20. 20. GERD is a more serious form of a common condition referred to as Gastro esophageal Reflux (GER)<br />GER occurs when the lower esophageal sphincter becomes incompetent. The failure of the sphincter to perform its function causes regurgitation of stomach contents into the esophagus.<br />The contents of the stomach include acidic digestive juices and food.<br />GERD<br />
  21. 21. The acid in the refluxed contents causes the burning sensation in the chest and throat referred to as heart burn or acid indigestion.<br />GER that is frequent and occurs more than twice a week is considered GERD<br />Risk factors include obesity and <br />GERD<br />
  22. 22. The primary symptom is recurrent heart burn.<br />Heart burn is described as a burning sensation in the lower part of the mid chest, behind the breast bone and mid abdomen.<br />It is possible to have GERD without heart burn<br />Dry cough, asthma symptoms and trouble swallowing.<br />Symptoms<br />
  23. 23. The cause is undetermined in some people<br />The lower esophageal Sphincter relaxes randomly<br />Anatomical abnormalities include hiatal hernia<br />The diaphragm helps the lower esophageal sphincter in its function<br />Duodenal ulcers and pyloric strictures that delay gastric emptying<br />What Causes GERD??<br />
  24. 24. The presence of a hiatal hernia creates optimal conditions for GERD however it is possible to have a hiatal hernia and no symptoms of GERD.<br />Other factors that facilitate the occurrence of GERD include obesity, pregnancy and smoking.<br />Food types such as chocolate, citrus fruits, fatty fried foods etc. potentiate reflux symptoms.<br />What Causes GERD??<br />
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  26. 26. Most people treat reflux with OTC medications without realizing the severity of their condition<br />It is recommended to seek help if one has been using OTC antacids or other reflux medications for more than 2 weeks<br />Treatment<br />
  27. 27. Lifestyle Changes <br />Smoking secession<br />Small frequent meals<br />Loose fitting clothes<br />Avoid laying down for up to 3 hours after a meal<br />Avoid food and beverages that exacerbate symptoms<br />Weight loss<br />Treatment<br />
  28. 28. Medications<br />Antacids (Neutralize the acid in stomach)<br />Foaming agents (Cover the stomach contents with foam to prevent reflux)<br />H2 blockers ( Decrease acid production)<br />Proton pump inhibitors ( Decrease acid production)<br />Prokinetics ( strengthen the LES and make the stomach empty faster)<br />Treatment<br />
  29. 29. Surgery<br />Fundoplication<br />Vagotomy<br />Tests for unresolved symptoms<br />Barium Swallow Radiograph <br />Upper endoscopy<br />pH monitoring<br />Treatment<br />
  30. 30. Esophagitis<br />Esophageal Strictures<br />Barrett’s Esophagus, occurs in 10% of GERD patients and 40 times more likely to develop into esophageal cancer<br />Esophageal cancer<br />Target System<br />
  31. 31. Barrett’s Esophagus<br />
  32. 32. Reflux Esophagitis<br />
  33. 33. Esophageal Stricture<br />
  34. 34. Unrelieved GERD can lead to asthma exacerbation, chronic cough and pulmonary fibrosis<br />If complications progress to esophageal cancer there is a high possibility of metastasis.<br />Alterations in nutritional intake.<br />Whole Body<br />
  35. 35. IBS is characterized by<br />Constipation<br />Diarrhea<br />Gas<br />All the above<br />Questions<br />
  36. 36. IBS is associated with<br />Diverticulum in the colon<br />Ulcerations in the colon<br />Colorectal cancer<br />Non structural complications<br />Questions<br />
  37. 37. Rome III is primarily used to?<br />Classify stages of IBS<br />Diagnose GERD<br />Diagnose IBS<br />None of the above<br />Questions<br />
  38. 38. Resection of the vagus nerve by vagotomy reduces symptoms GERD by<br />Increasing acid production<br />Promoting gastric emptying<br />Reducing acid production<br />Reducing gastric emptying<br />Questions<br />
  39. 39. Which complication of GERD most often leads to cancer?<br />Barrett's esophagus<br />Esophageal strictures<br />Esophageal varices<br />esophagitis<br />Questions<br />
  40. 40. McCance k., Huether S., Brashers V., Rote N., (2010). Pathophysiology- The Biological Basis for Disease in Adults and Children (745-765). Missouri:MosbyElsevier.<br />National Digestive Diseases Information Clearinghouse.Gastro Esophageal Disease.Retrieved March 20, 2011:<br />Reference<br />