Digestive malfunctions

Question 1

What are the causes of IBS?

Answer 1

Precise cause is not known, however known factors that appear to play a role include
-muscle contractions in the intestine. Natural to move food along but if they are too strong and long they can lead to gas, bloating and diarrhoea
If they are weak then it can lead to slow food passage and dry, hard stools

abnormalities in nervous system- poorly co-ordinated signals between brain and intestine can cause body to overreact to normal changes in digestive process = pain, diarrhoea and constipation

inflammation of intestines- increased number of immune system cells in intestines is associated with pain and diarrhoea

severe infection- can develop after gastroenteritis which is severe diarrhoea caused by bacteria/virus
can also be associated with bacterial overgrowth

changes in bacteria in the gut (microflora)
microflora = good bacteria
microflora in people with IBS may differ to non-sufferers

Question 2

What are the key triggers of IBS?

Answer 2

food-wheat, dairy, citrus fruit, beans, cabbage, carbonated drinks

stress- may aggravate symptoms but does not cause them

hormones- women twice as likely to develop IBS and symptoms may worsen during periods

Question 3

How can IBS effect a person?

Answer 3

abdominal pain
cramping/bloating
excess gas
diarrhoea or constipation
mucus In stool
may be times when it is worse or better
physical/intellectual/emotional/social etc

Question 4

What are the monitoring procedures for IBS?

Answer 4

Upper endoscopy-tube inserted down the throat, into oesophagus and camera allows upper digestive tract o be observed and obtain a biopsy from the small intestinal fluid to look for overgrowth of bacteria

Question 5

What is a biopsy?

Answer 5

a tissue sample

Question 6

What are some of the treatment methods for IBS?

Answer 6

avoid foods that trigger symptoms
eat foods that are high in fibre
drink lots
exercise regularly
get enough sleep
doctors may suggest that you eliminate the following from your diet:
high-gas foods (carbonated/alcoholic drinks), caffeine, raw fruit, cabbage, broccoli, cauliflower..)
gluten- can improve diarrhoea problems if eliminated (wheat, barley, rye)
FODMAPS- found in certain grains, vegetables fruit and dairy products. Some people are sensitive to certain carbohydrates such as fructose etc
counselling may be suggested if the patient suffers from depression or stress worsens their symptoms
medication to relieve bowel spasms, laxative and fibre supplements and antidepressants may be prescribed

Question 7

What are the symptoms of gallstones?

Answer 7

abdominal pain- biliary colic 
inflammation of gallbladder- cholecystitis
jaundice
a fever
persistent pain
excessive sweating
feel sick or vomiting

Question 8

What are the more serious problems caused by complicated gallstone disease?

Answer 8

high temperature
more persistent pain
rapid heartbeat
jaundice
itchy skin
diarrhoea
chills or shivering attacks
confusion
loss of appetite

Question 9

How are gallstones formed?

Answer 9

small stones that are made up of cholesterol forming in the gallbladder, there are no symptoms or effects unless they become trapped in the opening duct, inside the gallbladder

Question 10

When are gallstones more common?

Answer 10

if you are female and have children, take the combined pill or are under-going high dose oestrogen therapy
if you are overweight/obese
aged 40+ (older you are = higher the chances)
have a condition that affects the flow of bile (cirrhosis-scarring of the liver etc)
have crohn’s disease or IBS
have a close family member who has had gallstones
have recently lost weight
take an antibiotic called ceftriaxone

Question 11

what are the monitoring procedures for gallstones?

Answer 11

Murphy’s sign test helps determine if your gallbladder is inflamed. Consists of placing hand/fingers on upper-right area of tummy and asks you to breathe in. If this is painful then = inflamed

Ultrasound scan- a transducer is placed on skin and moves over your upper abdomen
sound waves sent from transducer through your skin and into body. They bounce back off the body tissues to form an image, taking around 10-15 mins

Question 12

What happens if stones are suspected to be in the bile duct?

Answer 12

if they are not seen on the ultrasound but are suspected, you may need an MRI or a cholangiography

Question 13

what are the treatment methods for gallstones?

Answer 13

no symptoms= active monitoring, as no immediate treatment is needed
Treatment may be required if patient has a condition that increases risk of developing complications, such as scarring of liver (cirrohosis), hypertension in liver (portal hypertension) and a complication of alcohol-related liver disease, diabeties
high levels of calcium may also lead to treatment, as can lead to gallbladder cancer later in life

Question 14

what is biliary colic?

Answer 14

also known as gallbladder attack/gallstone attack

when a sudden pain occurs due to a gallstone blocking the bile duct

Question 15

What are the treatment methods for biliary colic?

Answer 15

mild an infrequent pain = painkillers and advice

more frequent and severe pain = surgery recommended as gallbladder is not an essential organ

Question 16

can you explain the process of keyhole surgery for gallstones?

Answer 16

keyhole surgery- good as eliminates problem and not as invasive as open surgery, therefore shorter recovery time
known as laparoscopic cholecystectomy when gallbladder is removed
Happens when gallbladder is temporarily inflated with CO2, laparoscope is used and X-ray may also be taken of bile duct during operation if gallstones are suspected there, gas escapes via laparoscope when gallbladder has been removed and recovery time = 10 days, under general anaesthetic, taking around 60-90 minutes

Question 17

Can you explain the process of extracorporeal shock wave lithotripsy?

Answer 17

used for kidney stones
uses shock waves to break gallstones into smaller fragments and ‘sand’ which can then be dissolved easily with an oral bile acid pill
most effective in people with normal body weight, fewer than 3 stones and have good gallbladder function
can be uncomfortable so sedatives may be given tor educe discomfort from occasional attacks of biliary colic pain
mostly used to treat cholesterol stones and success varies
not super effective-designed for kidney stones

Question 18

what medication can be taken to dissolve gallstones?

Answer 18

ursodeoxycholic acid tablets can dissolve them if they are small and do not contain calcium
they are not prescribed very often though, as they are rarely effective, need to be taken for up to 2 years ( a long process)
can reappear once treatment has stopped
not recommended for pregnant and breastfeeding women
barrier methods eg: condoms should be used for sexually active women as it may effect oral contraceptive pills

Question 19

what prevention methods are used for gallstones? (limited evidence)

Answer 19

because of the role cholesterol plays to form gallstones, it is advisable to avoid eating too many foods with high saturated fat content such as
meat pies
sausage and fatty cuts of meat
butter, ghea and lard
cream
hard cheeses
cakes and biscuits
food containing coconut and palm oil
healthy diet recommended (5 a day), eating nuts, peanuts and cashews, fruit and veg
drinking small amounts of alcohol may reduce risk
rapid weight loss may disrupt bile chemistry and increase risk

Question 20

what are the symptoms of coeliac disease?

Answer 20

diarrhoea, fatigue and weight loss
bloating/gas abdominal pain
nausea, constipation and vomiting
difficulty getting pregnant, peripheral neuropathy (tingling and numbness in hands and feet)
ataxia (disorders that affect co-ordination, balance and speech) oedema (swelling of hands/feet/legs)
dermatitis herpetiformis- skin rash on elbows, knees and buttocks. Not a direct symptom of coeliac but an autoimmune response to gluten

Question 21

what are the causes of coeliac disease?

Answer 21

abnormal immune system reaction to the protein gluten, found in food such as bread, pasta, cereals and biscuits
immune system mistakes healthy cells and substances for unhealthy ones, therefore producing antibodies against them.
The mistaken substance is gliadin which makes up gluten
the antibodies
these antibodies cause your intestine to become red and inflamed, causing damage to the lining of the gut, flattening villi and reducing their ability to aid with digestion
Therefore, your intestine cannot digest the nutrients from food, causing coeliac symptoms

Question 22

What can trigger symptoms of coeliac disease?

Answer 22

eating oats, containing a protein called avenin which is similar to gluten
can run in families with a 10% risk
associated with a number of genetic mutations that effect HLA-DQ genes, which are responsible for the immune system
if you have a digestive system infection (rectaurius infection etc) during childhood, this can cause coeliac disease
introducing gluten to a baby’s diet before the age of 3 months (experts say wait until 6 months)
type 1 diabeties can increase risk, as well as thyroid conditions, ulcerative colitis (inflammation of colon condition), neurological disorders such as epilepsy and down’s syndrome /turner syndrome

Question 23

what are the testing and monitoring procedures for coeliac disease?

Answer 23

blood tests can see if coeliac disease antibodies are found in your blood (should continue to eat gluten as normal to avoid an inaccurate result)
a biopsy via an endoscope inserted into the mouth and passed into the small intestine, samples taken via a biopsy tool of the lining of the small intestine to check for coeliac disease

further blood tests after diagnosis can check for anaemia if caused by coeliac disease and level of vitamins, iron and minerals in the blood

Skin biopsy to confirm dermatitis herpetiformis

A DEXA scan to test for thinning of bones- type of x-ray that measures bone density, poor digestion and lack of nutrients can lead to osteoporosis

Question 24

what are the treatment methods of coeliac disease?

Answer 24

gluten free diet, referral to dietician after diagnosis is recommended- no barley, rye, wheat
extra vaccines including influenza jab, HIB/MENC vaccine as spleen can work less efficiently, making you more vulnerable to infection
not always required as spleen is not always effected
vitamin and mineral supplements for first 6 months to ensure digestive system can repair itself efficiently
dapsone for dermatitis herpetirformis if it takes longer for gluten free diet to clear the rash, this can cause headaches and depression, therefore a low dose is prescribed

Question 25

what are the treatments for refractory coeliac disease?

Answer 25

this is where symptoms continue even after gluten free diet

treatment includes corticosteroids (steroid medications) to help block the harmful effects of the immune system

Question 26

what are the effects of coeliac disease?

Answer 26

malabsorption- leads to iron deficiency, anaemia, vitamin B12 and folate deficiency anaemia and osteoporosis
malnutrition- leads to fatigue, dizziness. Treatments include more calories and supplements
lactose intolerance- calcium supplements = treatment
cancer- small bowel cancer, small bowel lymphoma, Hodgkin lymphoma
pregnancy related complications: low birth weight etc