4330IBS

Information about 4330IBS

Published on October 30, 2007

Author: Mee12

Source: authorstream.com

Content

如何評估 Irritable bowel syndrome :  如何評估 Irritable bowel syndrome 指導教授:劉副主任 報告者:內科護理長 5 steps of實證醫學:  5 steps of實證醫學 第一步就是找到一個''可以被回答''的問題 (Find a anwserable question ) 2. 文獻搜尋 3. 文獻評讀 4. 臨床應用 5. 稽核 Slide3:  允宜長期便秘算IBS嗎? 素月督導一緊張就腹痛拉肚子,是IBS嗎?? 副主任婦科手術後,一直找廁所,算IBS???!!! 您是IBS的一群嗎?! 大綱:  大綱 前言 定義 流行病學 臨床表現 診斷工具 調查 前言:  前言 門診及基層醫療院所有很多IBS的病患,IBS—無法被解釋的腹痛,與腸燥習慣有關。IBS不僅僅是相當普遍,而且引起病人的不適及社交負擔,所以近年來引起廣泛的注意 ( Delvaux,2003) 。 定義:  定義 1892年,Sir William Osler首度描述 ”mucous colitis”(黏膜性結腸炎)的特徵為”tubular casts”(管的型成物)通過,管的型成物內容包括黏膜、細胞碎片及腸砂(Maxwell & Mendall,1997)。 定義:  定義 1929年臨床醫師開始使用” irritable colon”這個名詞,主要特徵為腹痛及腸道障礙(Maxwell & Mendall,1997)。 目前在臨床上幾乎將” irritable colon”及”mucous colitis”都定義為IBS。 (Greenberg、Amitrone & Galiczynski,2002) 定義:  定義 IBS被定義與慢性的腹痛有關的腸道障礙,便祕及腹瀉交替。 特徵有腹痛、便祕、腹瀉,便祕及腹瀉並存(Goroll & Mulley,2000)。 流行病學:  流行病學 Delvaux,2003-- IBS在歐洲的點盛行率約10-20%,而生存期的盛行率更高 歐洲及美國所有的研究指出女性盛行率高於男性,且在成人期發生,一些研究表示女性盛行率高於男性可能因女性較男性病患求診頻繁 此類病症有20-50%求診於腸胃科 流行病學:  流行病學 IBS在全球的盛行率成人在9-22%之間,範圍相當廣泛,可能因為評估族群的不同,也可能因為使用不同的評估工具去診斷IBS。(Saito、 Locke、Talley、 Zinsmeister、Fett. & Melton, 2000) 臨床表現:  臨床表現 症狀開始出現於年輕成人時候-然後變成一個終身的煩惱腹瀉、便秘 腹脹感-排便後症狀會改善 患者常找洗手間 症狀常反覆發作,持續很久影響生活品質 臨床表現:  臨床表現 症狀開始出現於年輕成人時候-然後變成一個終身的煩惱腹瀉、便秘 腹脹感-排便後症狀會改善 患者常找洗手間 症狀常反覆發作,持續很久影響生活品質 (陳,2001) 臨床表現:  臨床表現 慢性反覆性症狀-持續數週或數月,臨 床上常見三大類症(童,2001)-- (一) 慢性無痛間歇性腹瀉 (二) 慢性間歇性腹痛與便秘 (三) 腹瀉與便秘交替出現 臨床表現:  臨床表現 (一) 無痛間歇性腹瀉(童,2001)-- 腹瀉大多發生在早上起床或早餐後 在三、四次很軟的大便或有夾雜一些黏液後-大多整天不會再有不舒服的感覺 有些則會像鉛筆樣細細的軟便-可持續數週或數月-之後有些自然緩解-一段時間後又再復發 患者常有腹脹的情形 臨床表現:  臨床表現 (二) 慢性間歇性腹痛與便秘(童,2001)-- 腹痛與便秘腹痛大多在左下腹 在排氣或排便後自然緩解 患者也常有腹部脹氣的情形 臨床表現:  臨床表現 (三) 腹瀉與便秘交替出現(童,2001)-- 以腹瀉為主 以便秘為主 腹瀉與便秘兩種情形反覆交替的發生 臨床表現:  臨床表現 造成大腸激躁症之病因及致病機轉,尚未完全明瞭,多年來一直認為這是腸道功能性障礙的問題,可能為腸道蠕動改變或內臟感知過於敏感(童,2001) 。 臨床表現:  臨床表現 其他,腸胃方面的症狀還包括腹脹、過多的腸氣、腸胃咕嚕聲、大便有黏液、口臭 、食慾不振、體重減輕、心灼感、反胃、噁心、嘔吐、便急(鄭,2003)。 臨床表現:  臨床表現 患者亦可表現出各種非腸道症狀;但卻與心理問題有相當密切關聯性,精神上的壓力,常引發患者之症狀發作,包括虛弱、疲勞、缺乏活力,肌肉疼痛、失眠、心悸 、神經緊張、頭暈、呼吸急促、頻尿、無月經、頭痛等(李,1997)。 診斷工具:  診斷工具 Manning criteria Kruis criteria Rome criteria Symptoms That May Warrant a More Extensive Evaluation:  Symptoms That May Warrant a More Extensive Evaluation *Age of onset symptoms › 50 years *Progression or worsening of symptoms without periods of relief *Nighttime symptoms *Rectal bleeding *Anemia , hypoalbuminemia *Anorexia Symptoms That May Warrant a More Extensive Evaluation:  Symptoms That May Warrant a More Extensive Evaluation *Recurrent vomiting *Family history of colon cancer *Abnormal physical findings (such as a mass) *Extraintestinal manifestations , as seen in inflammatory bowel disease *Unexplained weight loss 調查:  調查 本組針對新陳代謝科、神經內科、精神科、血腫科、心臟內科、婦科、神經外科、胸腔內科等共50位臨床醫師,對IBS瞭解度進行初探 96%的臨床醫師表示,瞭解何謂IBS 實際診斷過IBS的醫師佔52%,但仍有48%的醫師並無相關診斷經驗 Slide24:  診斷次數由1次至上百次不等,其中有2位腸胃科醫師指出,IBS約佔每次看診人數之10% 4%使用Rome criteria;8%使用Rome I criteria;其餘醫師仍多依病患臨床症狀診斷IBS。 結論:  結論 允宜算IBS嗎? 素月督導是IBS嗎?? 副主任算IBS???!!! 您是屬於流行病學中的10%嗎? 參考資料:  參考資料 Goroll, A. H., & Mulley, J. A.(2000). Primary care medicine. (4th ed., pp.485-490). Philadelphia: Lippincott Williams & Wilkins. Greenberg, M. R., Amitrone, M., & Galiczynski, E. M.(2002). A contemporary review of irritable bowel syndrome. Physician Assistant, 26 (8), 26-34. Delvaux, M.(2003). Functional bowel disorders and irritable bowel syndrome in Europe. Aliment Pharmacology Therapy, 18(Suppl.3), 75-79. 參考資料:  參考資料 Maxwell, P. R., & Mendall, M. A.(1997).Irritable bowel syndrome. Lancet, 1997(350), 1691-1693. Saito, Y. A., Locke, G. R., Talley, N. J., Zinsmeister, A. R., Fett, S. L., & Melton, L. J. III. (2000). A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. American J Gastroenterology, 95(10), 2816-2824. 敬請指教:  敬請指教 Manning Criteria (1978):  Manning Criteria (1978) A validation study of the Manning criteria, by Talley and colleagues, found a sensitivity of 58% and specificity of 74% in discriminating IBS from a variety of organic gastrointestinal diseases. Other studies have reported a sensitivity varying from 58% to 81% and specificity from 67% to 87%. Kruis(1984):  Kruis(1984) Main points: A scoring system including the answers of a questionnaire and the results of eight basic investigations was established. Using the weighted score (more than 44 points), at a sensitivity of 64%, the specificity for the diagnosis of IBS was 99%. Rome I, Rome II, Rome III, and the Rome committees: Terminology and Bibliography (by Drossman D. A.) :  Rome I, Rome II, Rome III, and the Rome committees: Terminology and Bibliography (by Drossman D. A.) Rome I: All documents published in the Gastroenterology International Journal from 1992 -1995 as well as Rome I book is considered as Rome I. Rome II: All documents published either in the GUT Supplement (4;16-26;1999) or the book is considered as Rome II. Rome III: a committee was formed in 2001 for Rome III. They included Drossman, Corazziari, Delvaux, Spiller, Talley, Thompson and Whitehead. The committee will begin their work in May, 2003 and the publications will be released in 2006 as a supplement in Gastroenterology, and as the Rome III book. All documents published in 2006will be considered as Rome III.

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