IBS, classification of IBD, causes/risk factors, pathophysiology, assessment and diagnostic findings, complications, treatment, nursing intervention

1. Irritable bowel
syndrome
Prepared by
Mehwish Jamil

2. Objectives
At the end of this lecture students will be
able to:
 Define IBS.
 Explain risk factors of IBS.
 Enlist sign and symptom of IBS.
 Describe the pathophysiology of IBS.
 Explain the assessment and diagnostic
finding of IBS.
 Explain the medical and nursing intervention
of IBS.

3. Irritable bowel syndrome
IBS is a mix of belly discomfort or pain and
trouble with bowel habits: either going more or
less often than normal (diarrhea or constipation)
or having a different kind of stool (thin, hard, or
soft and liquid).

4. Conti…
There are four types of the condition:
• IBS with constipation (IBS-C)
• IBS with diarrhea (IBS-D)
• Mixed IBS (IBS-M) alternates between
constipation and diarrhea
• Unsubtyped IBS (IBS-U) for people who don't fit
into the above types

5. Risk factors
 more commonly in women than in men, and
the cause remains unknown.
 Age
 Family history
 psychological stress or conditions such as
depression and anxiety
 a diet high in fat
 stimulating or irritating foods
 alcohol consumption
 and smoking.

6. IBS Symptoms
 People with IBS have symptoms that can include:
• Diarrhea (often described as violent episodes of
diarrhea)
• Constipation
• Constipation alternating with diarrhea
• Belly pains or cramps, usually in the lower half of the
belly, that get worse after meals and feel better after
a bowel movement
• A lot of gas or bloating

7. Conti…
• Harder or looser stools than normal (pellets or flat ribbon
stools)
• A belly that sticks out
• Mucus in your poop
• Feeling like you still need to poop after you just did
• Food intolerance
• Tiredness
• Anxiety
• Depression
• Heartburn and indigestion
• Headaches
• Needing to pee a lot

8. pathophysiology
 neuroendocrine
dysregulation
 infections
 inflammatory disorders
 vascular or
 metabolic disturbance
peristaltic waves are affected at
specific segments of the intestine
and in the intensity with which
they
propel the fecal matter forward
Irritable bowel syndrome

9. Assessment and diagnostic finding
 Specific diagnostic criteria established through
international consensus conferences have led to
improved diagnosis of IBS.
 Criteria include:
 recurrent abdominal pain or discomfort for at least 3
days a month in the past 3 months, including two or
more of the following:
 (1) improvement with defecation;
 (2) onset associated with change in frequency of
stool;
 and (3) onset associated with change in appearance
(form) of stool

10. Diagnosis
 A definite diagnosis requires tests that confirm the
absence of structural or other disorders.
 Stool studies
 Contrast x-ray studies
 proctoscopy may be performed to rule out other colon
diseases.
 Barium enema and colonoscopy may reveal spasm,
distention, or mucus accumulation in the intestine .
 Manometery and electromyography (EMG) are used
to study intraluminal pressure changes generated by
spasticity.

11. Treatment
 The goals of treatment are:
 relieving abdominal pain
 controlling the diarrhea or constipation
 and reducing stress.

12. Conti…
Diet
 Restriction and then gradual reintroduction of
foods that are possibly irritating may help
determine what types of food are acting as
irritants (e.g., beans, caffeinated products, corn,
wheat, dairy lactose, fried foods, alcohol, spicy
foods, aspartame)
 A high-fiber diet is prescribed to help control the
diarrhea and constipation.
 Exercise

13. CONTI…
 Medication
 Hydrophilic colloids (i.e., bulk) and antidiarrheal
agents (e.g., loperamide) may be given to control the
diarrhea and fecal urgency.
 Antidepressants(dual benefit)
 Anticholinergic or antispasmodics(e.g., propantheline
[Pro-Banthine]) may be prescribed to decrease
smooth muscle spasm, decreasing cramping and
constipation.
 Tegaserod
 Probiotics are bacteria that include Lactobacillus and
Bifidobacterium that can be administered to help
decrease abdominal bloating and gas.

14. Nursing intervention
 The nurse’s role is to provide patient and family
education.
 Teaching and reinforcement of good dietary habits
(eg, avoidance of food triggers) are emphasized.
 A good method for identifying problem foods involves
keeping a symptom and food diary for 1 to 2 weeks.
 Patients are encouraged to eat at regular times and
to chew food slowly and thoroughly.
 They should understand that although adequate fluid
intake is necessary, fluid should not be taken with
meals because this results in abdominal distention.

15. Conti…
 Alcohol use and cigarette smoking are
discouraged.
 Stress management via relaxation techniques,
yoga, or exercise can be recommended.