16. Diseases of the large bowel. Functional GI disorders Flashcards
What are the Rome IV criteria for functional esophageal disorders?
- Functional heartburn,
- functional chest pain,
- functional dysphagia,
- globus
- reflux hypersensitivity.
What is the diagnosis for functional heartburn?
- Burning retrosternal pain
- Lack of acid reflux or esophagitis,
- absence of esophageal motility disease.
What is the diagnosis for functional chest pain?
- Non-burning retrosternal chest pain not caused by heartburn or dysphagia
- absence of acid reflux or eosinophilic esophagitis
- absence of esophageal motor disorders
What is the diagnosis for functional dysphagia?
- Impaired swallowing of solid or liquid nutrients,
- lack of acid reflux or structural abnormality,
- non-specific esophageal motility disease.
What is the diagnosis for globus?
Feeling of foreign body in throat, continuously or intermittently between meals, with
- absence of dysphagia,
- absence of esophagitis or acid reflux,
- and absence of esophageal motility disease.
What is reflux hypersensitivity?
- Retrosternal synptoms like chest pain
- Normal endoscopy, no Eoesophagitis,
- no esophageal motor disorders,
- normal pH.
What are the functional gastroduodenal diseases?
- Functional dyspepsia,
- belching,
- nausea, vomiting
- Rumination
What is included in functional dyspepsia?
Epigastric pain syndrome and postprandial distress syndrome.
What are the two types of belching?
Aerophagia and immoderate belching.
What are the three subtypes of vomiting syndrome?
- Chronic idiopathic nausea,
- functional vomiting syndrome,
- cyclic vomiting syndrome.
What are the symptoms of PDS?
Bother some early satiety or postprandial fullness present at least three times per week.
What are the symptoms of EPS?
Epigastric or burning pain that can be induced or worsened during a meal.
What is the pharmacological therapy for functional gastroduodenal diseases?
- H Pylori eradication
- PPI
- Prokinetics
- H2 antagonists
- Tricyclic antidepressants for refractory symptoms (mirtazapine, buspirone)
What is aerophagia?
It is the swallowing of air, which can lead to excessive belching.
What is cyclic vomiting syndrome?
It is a condition characterized by episodes associated with vomiting, with the patient being asymptomatic between episodes.
What is rumination?
It is the return of ingested food to the oral cavity, followed by spitting or chewing and swallowing, without nausea.
What are the four functional colon disorders?
- functional bloating,
- functional constipation,
- functional diarrhea,
- irritable bowel syndrome.
What are the diagnostic criteria for irritable bowel syndrome?
- Recurrent abdominal pain with a change in stool form and/or frequency,
- With abdominal pain related to defecation.
What are some differential diagnoses for IBS?
They include colorectal cancer, ovarian cancer, bile salt malabsorption, microscopic colitis, coeliac disease, and Crohn’s disease.
What is the therapy for IBS?
- a good patient-doctor relationship,
- reduction in lactose, high-starch and sugary foods
- low FODMAP diet.
- increased physical activity
- improved management of stress
What is functional stool incontinence?
Recurrent involuntary defecation with maintained muscle morphology and innervation due to psychological reasons.
What do we need to exclude for functional stool incontinence?
Brain, spinal or sacral nerve route alterations, peripheral or autonomic neuropathy.
What is functional anorectal pain syndrome?
Chronic or intermittent rectal pain lasting for minutes or longer.
What do we need to exclude for functional anorectal pain syndrome?
Ischemia, IBD, intramuscular abscess, fissure, hemorrhoids, prostatitis, coccygodynia.
What is chronic proctalgia?
Chronic anorectal pain lasting for minutes or longer.
What is proctalgia fugax?
Intermittent sharp pain in the rectum or anus lasting for seconds to minutes.
What are the different types of functional anorectal pain syndromes?
There are two types: chronic proctalgia and proctalgia fugax.
What is dyssynergic defecation?
Dyssynergic defecation is a functional defecation disorder characterized by
- incomplete evacuation,
- incomplete contraction of the pelvic muscles,
- incomplete sphincter relaxation.
What is diverticulosis?
Bulging of mucosa, submucosa and muscularis externa through the muscular layer of the colon
What is the difference between a pseudodiverticulum and a diverticulum in diverticular disease?
Pseudodiverticulum is bulging of mucosa and submucosa through the muscular layer, while diverticulum is bulging of every layer.
What is the pathophysiology of diverticular disease?
- Oral obstruction of the diverticulum,
- irritation of food residues,
- mucosal injury,
- local bacterial overgrowth leading to inflammation.
What is the triad of symptoms in diverticulitis?
Left LQ pain, fever, leukocytosis.
How is diverticulitis diagnosed?
- History,
- physical examination,
- lab tests (WE, CRP, leukocytosis),
- imaging (US, CT - gold standard).
- Colonoscopy
What is the therapy for symptomatic, uncomplicated diverticulosis?
- Diet and lifestyle changes,
- ensuring proper fiber intake,
- and antibiotic rifaximin.
What is the therapy for acute diverticulitis?
- Broad-spectrum antibiotic for 7-10 days or observation (ampicillin-sulfabactam / ciprofloxacin-metronidazole)
- might need hospitalisation (if risk population)
What is the recommended therapy for diverticular bleeding?
- Angiographic embolisation : vasopressin
- Endoscopic therapy : cauterisation, clips
What is the recommended therapy for diverticular abscess?
<4cm
- Parentéral feeding
- IV antibiotics
> 4cm
- US or CT guided drainage
Fistulas
- Resection of affected intestinal tract
What are the risk factors for NSAID ulcers?
- > 65 years,
- preceding ulcer,
- corticosteroid/big dose NSAID
- oral anticoagulants,
- smoking, alcohol,
- Helicobacter pylori infection.
What is the pathognomonic sign of NSAID-induced small bowel side effects?
Concentric stricture.
What are the clinical symptoms of NSAID enteropathy?
- Obscure GI bleeding,
- hematochezia or melena,
- anemia.
- erosions and ulcers
What is the colonic side effect of NSAIDs?
Diverticulitis and diverticular bleeding,
What are the diagnostic methods for NSAID enteropathy?
- Endoscopy,
- capsule endoscopy,
- enteroscopy,
- determination of urinary 51-Chromium-labeled ethylenediamine acetic acid,
- fecal calprotectin.
What are the complications of NSAID enteropathy?
- Fe-deficiency anemia,
- protein loss enteropathy / hypalbuminemia.
- perforation
What are the therapies for NSAID enteropathy?
- Misoprostol,
- Metronidazole - lowers NSAID induced permeability
- Sulphasalazine (!!) - decreases inflammation and anemia,
- rebamipide - mucosal protection,
What is ischemic colitis?
Ischemic colitis is a condition where there is inadequate blood supply to the colon, leading to decreased bowel motility, abdominal pain, and bloody stools.
What are the causes of ischemic colitis?
- constriction or embolization of the superior and inferior mesenteric arteries
- in some cases, no specific cause can be identified.
What are the symptoms of ischemic colitis?
- hyperactive phase (severe abdominal pain and bloody stools),
- paralytic phase (widespread abdominal pain, decreased bowel motility, bloating, and no further bloody stools),
- shock phase (leaky gut, dehydration, low BP, metabolic acidosis, tachycardia, and confusion).
What is the therapy for ischemic colitis?
- IV fluid,
- bowel rest,
- antibiotics covering aerobic and anaerobic bacteria,
- surgical intervention if necessary.
What is chronic idiopathic nausea ?
- Nausea more than once a week
- No metabolic disease
- Negative pan endoscopy
What drugs can be given for IBS?
- spasmolytic Ca antagonists (pinaverin),
- laxatives,
- TCA
- SSRI
- rifaximin
What is an example of diverticulosis?
Meckel’s diverticulum
Which drugs can be used to lower NSAID complications?
- phosphatidylcholine, in combination with ibuprofen,
- nitrogen monoxide
- H2S-producing NSAIDs.
How to differentiate ischemic colitis and mesenteric ischemia?
Mesenteric ischemia has weight loss, nausea and vomiting, and not always bloody stool
