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#fm
Initial investigations & basic management for chr/recurrent abdo pain

  • IBS

    • Exercise: vigorous 3-5/week (all types of IBS)

    • Laxatives: OTC ( polyethylene glycol (PEG - osmotic) - Miralax); only helps w/ constipation

    • Antidiarrheal: OTC loperamide (imodium); likely only helps diarrhea

    • Probiotics: in some OTC supplements & yogurts (lactobacillus, bifidobacterium, streptococcus)

      • To prevent worsening sx

    • Abx

      • Diarrheal/mixed: rifaximin (Xifaxan); prevent worsening global sx over 4wk

      • Constipation: neomycin; improve constipation & bloating

    • Antispasmodics: hyoscyamine (Levsin), dicyclomine (Bentyl)

    • Selective C-2 chloride channel activators: lubiprostone (Amitiza) - constipation

    • Antidepressants

      • SSRI - citalopram (celexa), fluoxetine (prozac), paroxetine (paxil)

      • TCA - amitriptyline , desipramine (norpramin), doxepin , imipramine (tofranil), trimipramine (surmontil)

    • Other: relaxation, herbals, peppermint oil

    • Not routinely recommended: CBC, lytes, thyroid, stool testing for ova & parasites, abdo img

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Abdo Pain
#13; *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain <span>Initial investigations & basic management for chr/recurrent abdo pain IBS Exercise: vigorous 3-5/week (all types of IBS) Laxatives: OTC (polyethylene glycol (PEG - osmotic) - Miralax); only helps w/ constipation Antidiarrheal: OTC loperamide (imodium); likely only helps diarrhea Probiotics: in some OTC supplements & yogurts (lactobacillus, bifidobacterium, streptococcus) To prevent worsening sx Abx Diarrheal/mixed: rifaximin (Xifaxan); prevent worsening global sx over 4wk Constipation: neomycin; improve constipation & bloating Antispasmodics: hyoscyamine (Levsin), dicyclomine (Bentyl) Selective C-2 chloride channel activators: lubiprostone (Amitiza) - constipation Antidepressants SSRI - citalopram (celexa), fluoxetine (prozac), paroxetine (paxil) TCA - amitriptyline, desipramine (norpramin), doxepin, imipramine (tofranil), trimipramine (surmontil) Other: relaxation, herbals, peppermint oil Not routinely recommended: CBC, lytes, thyroid, stool testing for ova & parasites, abdo img <span><body><html>


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