Case Study For Irritable Bowel Syndrome

IRRITABLE BOWEL SYNDROME
INTRODUCTION
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). IBS is also known as spastic colon,
irritable colon, mucous colitis, and spastic colitis.
CAUSES AND RISK FACTORS
The precise cause of IBS isn’t known. Factors that appear to play a role include:
• Muscle contractions in the intestine. The walls of the intestines are lined with
layers of muscle that contract as they move food through your digestive tract.
Contractions that are stronger and last longer than normal can cause gas,
bloating and diarrhea. Weak intestinal contractions can slow food passage and
lead to hard, dry stools.
• Nervous system. Abnormalities in the nerves in your digestive system may cause
you to experience greater than normal discomfort when your abdomen stretches
from gas or stool. Poorly coordinated signals between the brain and the intestines
can cause your body to overreact to changes that normally occur in the digestive
process, resulting in pain, diarrhea or constipation.
• Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis)
caused by bacteria or a virus. IBS might also be associated with a surplus of
bacteria in the intestines (bacterial overgrowth).
• Early life stress. People exposed to stressful events, especially in childhood, tend
to have more symptoms of IBS.
• Changes in gut microbes. Examples include changes in bacteria, fungi and
viruses, which normally reside in the intestines and play a key role in health.
Research indicates that the microbes in people with IBS might differ from those in
healthy people.
Many people have occasional signs and symptoms of IBS. But you’re more likely to
have the syndrome if you:
• Are young. IBS occurs more frequently in people under age 50.
• Food. Certain food type of foods may trigger IBS such as dairy product, citrus
fruit, cabbage, carbonated drinks and beans.
• Are female. In the United States, IBS is more common among women. Estrogen
therapy before or after menopause also is a risk factor for IBS.
• Have a family history of IBS. Genes may play a role, as may shared factors in a
family’s environment or a combination of genes and environment.
• Have anxiety, depression or other mental health issues. A history of sexual,
physical or emotional abuse also might be a risk factor.
PATHOPHYSIOLOGY
DIAGNOSIS
• Colonoscopy. Your doctor uses a small, flexible tube to examine the entire length
of the colon.
• X-ray or CT scan. These tests produce images of your abdomen and pelvis that
might allow your doctor to rule out other causes of your symptoms, especially if
you have abdominal pain. Your doctor might fill your large intestine with a liquid
(barium) to make any problems more visible on X-ray. This barium test is
sometimes called a lower GI series.
• Upper endoscopy. A long, flexible tube is inserted down your throat and into the
tube connecting your mouth and stomach (esophagus). A camera on the end of
the tube allows the doctor to inspect your upper digestive tract and obtain a
tissue sample (biopsy) from your small intestine and fluid to look for overgrowth
of bacteria. Your doctor might recommend endoscopy if celiac disease is
suspected. Laboratory tests can include:
• Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar
found in dairy products. If you don’t produce lactose, you may have problems
similar to those caused by IBS, including abdominal pain, gas and diarrhea. Your
doctor may order a breath test or ask you to remove milk and milk products from
your diet for several weeks.
• Breath test for bacterial overgrowth. A breath test also can determine if you have
bacterial overgrowth in your small intestine. Bacterial overgrowth is more
common among people who have had bowel surgery or who have diabetes or
some other disease that slows down digestion.
• Stool tests. Your stool might be examined for bacteria or parasites, or a digestive
liquid produced in your liver (bile acid), if you have chronic diarrhea.
MEDICAL MANAGEMENT
Treatment of IBS focuses on relieving symptoms so that you can live as normally as
possible. Mild signs and symptoms can often be controlled by managing stress and by
making changes in your diet and lifestyle. Try to:
• Avoid foods that trigger your symptoms
• Eat high-fiber foods
• Drink plenty of fluids
• Exercise regularly
• Get enough sleep
Your doctor might suggest that you eliminate from your diet:
• High-gas foods. If you experience bloating or gas, you might avoid items such as
carbonated and alcoholic beverages and certain foods that may lead to increased
gas.
• Gluten. Research shows that some people with IBS report improvement in
diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they
don’t have celiac disease.
• FODMAPs. Some people are sensitive to certain carbohydrates such as fructose,
fructans, lactose and others, known as FODMAPs — fermentable
oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are
found in certain grains, vegetables, fruits and dairy products.
Based on your symptoms your doctor might suggest medications such as:
• Fiber supplements. Taking a supplement such as psyllium (Metamucil) with fluids
may help control constipations
• Laxatives. If fiber doesn't help constipation, your doctor may recommend over-
thecounter laxatives, such as magnesium hydroxide oral (Phillips' Milk of
Magnesia) or polyethylene glycol (Miralax).
• Anti-diarrheal medications. Over-the-counter medications, such as loperamide
(Imodium A-D), can help control diarrhea.
• Anticholinergic medications. Medications such as dicyclomine (Bentyl) can help
relieve painful bowel spasms. These medications are generally safe but can
cause constipation, dry mouth and blurred vision.
• Tricyclic antidepressants. This type of medication can help relieve depression as
well as inhibit the activity of neurons that control the intestines to help reduce
pain.
• SSRI antidepressants. Selective serotonin reuptake inhibitor (SSRI)
antidepressants, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may
help if you are depressed and have pain and constipation.
• Pain medications. Pregabalin (Lyrica) or gabapentin (Neurontin) might ease
severe pain or bloating.
NURSING INTERVENTIONS
1. Explore the patients daily nutritional intake and food habits.
2. Help patient choice appropriate dietary choices to reduce intake of milk, high
fiber, high fat foods and alcohol.
3. Refer the patient to a dietitian
4. For an IBS patient with severe diarrhea, place the patient into Nothing by
mouth(NBM) status and gradually progress to clear liquids followed by bland diet
and low residual diet.
5. Administer prescribed medication that alleviate the symptoms of stomach pain.
6. Assess patients vital signs and characteristic of pain at least 30 mins after
medication.
7. Teach patient how to do non-pharmacological pain method.
COMPLICATIONS
• Poor quality of life. Many people with moderate to severe IBS report poor quality
of life. Research indicates that people with IBS miss three times as many days
from work as do those without bowel symptoms.
• Mood disorders. Experiencing the signs and symptoms of IBS can lead to
depression or anxiety. Depression and anxiety also can make IBS worse.

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IRRITABLE BOWEL SYNDROME

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