Chronic abdominal functional pain Flashcards by Hannah Nolan

What is IBS

Functional bowel condition causing altered bowel habit and pain

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Criteira for IBS

> 6 months of
Abdominal pain - cramping - relieved by defecation often
Bloating
Costipation - +/- diarrhoea - altered bowel frequency or form, mucus

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What is IBS ass with

Lethargy, nausea, backache, bladder dysfunction, depression and aniety

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Red flags to investigate in IBS

Rectal bleeding
Unexplained weight loss
FH of bowel/ovarian cancer
>60 yrs and >6 weeks change to bowel habit
Anaemia
Abdominal/rectal masses
Raised inflammatory markers

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Investigations for IBS

FBC
CRP/ESR
anti-TTG
Faecal calprotectin - IBD

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What is functional dyspepsia

Upper GI pain and delayed gastric emptying
Dyspepsia
Nausea
Early satiety
Bloating
Icreased burping

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Investigations for functional dyspepsia

Bloods, H pylori
Endoscopy for ulcers etc
Red falgs and ALARM symptoms

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Epidemiology functional dyspepsia

60% recurrent dyspepsia have fucntional disease
1 in 3 also have IBS

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Definition of centrally mediated/functional abdominal pain syndrome criteria

> 6 months of abdominal pain w no explanation

ROME III criteria =
Pain nearly continious for at least 3 months
Not or minimal relation to eating, defecation, menses
Impairs daily functioning
Not attributable to another medical condition

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epidemiology of centrally mediated abdominal pain

2% adults
Female/young adults and adolescents with life/social stressors

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Criteria for abdominal migraine

Paroxysmal episodes of central abdominal pain >1 hour
Ass w nausea, vomitting, loss of appetite and someitmes headache/photophobia
Long symptom free periods between episodes
May develop migraines in adulthood

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Theories about causes of abdominal pain

gut function and motility disruption, gut microbiota alteration, biochemical changes and psychological factors - anxiety and deression rates higher

Factors that can cause childhood functional pain

Nociceptive somatic stimuli early in neonatal period
Neonatal gastric suction
Psych - abuse, separated from best friend, failure in examination, loss of parents job, hospitalisation

Pathophysiology of childhood abdo ain

Genetic predisposition
GI infection, mast cell dysfucntion, serotonin, abnormal rectal sensory threshold, alteration of gut microbiota
Poor gastric emptying and poor antral motility
Abnormal gastric accommodation
Abnormal myoelectrical activity

RED FLAGS TO EXCLUDE IN functional abdominal pain

see notion
Come up w own loist

What to understad about patient w fun tional disorder

Life history of illness
Reasons for seeking care
Life history traumatic events
Patients understanding of illness
Impact of pain on activities and quality of life
Associated psych disorders
Role of family and culture
Ass psych impairment and vailable resorurces

General measures functional abdominal pain

Supportive environemtn
Validation of symptoms
Patient education
Agree and set realistic treatment goals

Pharmacological treatments functional abdominal pain and step ups

TCAs
SNRIs

Gabapentin
Pregabalin

Psychological interventions for functional abdominal pain

CBT
Hypnotherapy

Red flags for pelvic pain

Post coital bleeding
Post menopausal bleeding
PR bleeding
New GI symptoms eg constipation, early satiety esp >50s
Pelvic mass
Unexpected weight loss

How to differentiate funcitonal pelvic pain from endometriosis

Cyclical nature

Gold standard investigation for endometriosis

Laparascopy

When should a laparoscopy be done for endometriosis

"when the index of suspicion of adhesive disease or endometriosis requiring surgical intervention is high, or when the patient has specific concerns which could be addressed by diagnostic laparoscopy such as the existence of endometriosis or adhesions potentially affecting her fertility."

Non cardiac chest pain causes

GI - GORD, oesophageal spasm, swallow pathology Resp - pkeurisy, pneumonia, PE, cacner MSK - chsotochrondritis, trauma, bony mets - tender and worse on movement Psych - generalised anxiety, panic disorder. Adrenaline - racing heart, palpitations Functional - nor orgnaic explanation

Cardiac causes of palpitations

AF/flutter SVT Other arrhythmias Ectopics Sinus tachycardia Structural HD

Concerning features of palpitations

Accompanying chest pain, lightheadedness or syncope FH of suddenc ardiac death ECG changes eg prolonged QTc, brugada pattern, delta waves Cardiac co-mobidities eg severe LVSD, known IHD, structural HD

Non cardiac causes of palpitations

anxiety, panic disorder, hyperthyroidism, pheochromocytoma, anaemia, menopause, caffeine, recreational drugs, drug withdrawal, beta-2 agonists e.g. salbutamol etc.

Investigation for palpitations

CVS exa 12 lead ECG Relevant blood tests ECG monitor or loop recorders w a symptom diary If sus pathology: Refer to cardiology ECHO

What are ectopic beats

Missed beat then a heavy squeeze

Atrial vs ventricular extopics and when concerning

Atrial - common no effect on prognosis Ventricular - caffeine and stress, increase with age Heavy burden of ventriuclar ectopics eg bigeminy - every other HB an ectopic

What can sinus tachycardia be caused by

Sepsis, PE Anxiety - increased catecholamine release