Bowel Disorders Flashcards
what are the 2 broad categories of GI disease?
> structural
> functional
what are the effects of functional GI disorders?
> impact quality of life
cause absence from work
no association with development of serious pathology
what could cause non-ulcer dyspepsia?
> reflux
low grade duodenal ulceration
delayed gastric emptying
irritable bowel syndrome
how would you diagnose non-ulcer dyspepsia?
> history and examination
h. pylori status
alarm symptoms
is all investigations are negative in the diagnosis of non-ulcer dyspepsia how do you proceed?
> treat symptomatically
> do endoscopy if in doubt
describe retching
dry heaves where the antrum contracts but the glottis is closed
what would immediate vomiting after eating suggest?
it is psychogenic
in obstruction how long would you expect there to be between eating and vomiting?
12 hours
what conditions may cause vomiting an hour or more after eating?
> pyloric obstruction
> motility disorders: diabetes, post gastrectomy
name some functional causes of vomiting
> drugs > pregnancy > migraine > cyclical vomiting > alcohol
name some functional diseases of the lower GI tract
> irritable bowel syndrome
> slow transit constipation
what would you consider when asking about changes in bowel habit?
> what is their normal > changes in frequency > changes in consistency > blood present > mucus
name some alarm symptoms
> >50years > short history > weight loss > nocturnal symptoms > male > family history of cancer > anaemia > rectal bleeding > antibiotic use > abdominal mass
what is the aetiology of constipation? (four broad categories)
> systemic
neurogenic
organic
functional
what investigations could you carry out when assessing the patient after history is taken?
> FBC > U and Es > blood glucose > thyroid status > coeliac serology > proctoscopy > sigmoidoscopy > colonoscopy
what organic things can cause constipation?
> strictures > tumours > diverticular disease > proctitis > anal fissure
what functional reasons can there be for constipation?
> megacolon > idiopathic > depression > psychosis > institutionalisation
what are the systemic causes of constipation?
> diabetes mellitus
hypothyroidism
hypercalcaemia
what are the neurogenic causes of constipation?
> autonomic neuropathies > parkinson's disease > strokes > multiple sclerosis > spina bifida
what are the clinical features of irritable bowel syndrome?
occur relapsing and remitting manner: > abdominal pain > altered bowel habit > abdominal bloating > wind
what are the features of abdominal pain in IBS?
> variable character
occasionally radiates to lower back
often altered by bowel action
rarely occur at night
describe altered bowel habit in IBS
> constipation (IBS-C) > diarrhoea (IBS-D) > diarrhoea and constipation (IBS-M) > variable > urgency
what causes bloating in IBS?
relaxation of the abdominal wall muscles
how would you diagnose IBS?
> compatible history
> normal physical examination
what investigations could you carry out for IBS?
> blood analysis
stool culture
calprotectin
what releases calprotectin?
inflamed gut mucosa
what is calprotectin used for clinically?
differentiating IBS from IBD and monitoring IBD
what is the treatment for IBS?
> education and reassurance > diabetic review > drug therapy > relaxation training > hypnotherapy > cognitive behaviour therapy > psychodynamic interpersonal therapy
what can cause IBS?
> altered motility
visceral hypersensitivity
stress/anxiety/depression
how do contractions of the bowel differ in IBS-D?
they are stronger and more frequent
describe bowel contractions in IBS-C
they are reduced
how may contractions of the bowel be triggered?
by waking or eating
what type of IBS has a greater response to trigger of gut contractions?
IBS-D
how does awareness of normal digestive processes differ in people with IBS?
they often have excessive awareness
