Functinal GI Disorders Flashcards
What are the two broad categories of functinoal GI disorders?
Structural
Functional
Define what is meant by a structural disorder?
Detectable pathology
- Macroscopic e.g. a Cancer
- Microscopic e.g. Colitis
What is meant by a functional disorder?
lNo detectable pathology
lRelated to gut function
l“Software faults”
Long-term prognosis good
What are examples of functional GI disorders?
Oesophageal spasm
Non-Ulcer Dyspepsia (NUD)
Biliary Dyskinesia (bile physically can not move normally in the proper direction through the tubular biliary tract)
Irritable Bowel syndrome
Slow Transit Constipation
Drug Related Effects
What is meant by non-ulcer dyspepsia?
Dyspeptic type pain
No ulcer on endoscopy (H pylori status varies)
Probably not a single disease
- Reflux
- Low grade duodenal ulceration
- Delayed Gastric emptying
- Irritable bowel syndrome
What is the diagnosis of non ulcer dyspepsia?
- Careful History and Examination
- Family History
- Gastric Cancer rare in those under 45 years
- H. pylori status
- Alarm symptoms
If all negative treat for symptoms
If H pylori positive eradication therapy
If doubt - endoscopy
What causes retching?
Contraction of antrum, closed glottis
What is the cause of vomiting immediately after food?
Psychogenic
What is the cause of vomiting 1 hour or more after food?
- Pyloric obstruction
- Motility disorders including:
Diabetes
Post gastrectomy
What is the cause of spewing 12 hours after eating?
Obstruction
What are the functional causes of vomiting?
Drugs
Pregnancy
Migraine
Cyclical vomiting syndrome
Alcohol
What are the functional diseases of the lower GI tract?
IBS
Slow transit Constipation
What might a patient consider constipation?
“Hard stool”
“Incomplete evacuation”
“Difficult evacuation”
What are alarm symptoms?
What are the investigations for functional disorders of the lower GI tract?
Investigation
- FBC
- Blood glucose
- U + E, etc.
- Thyroid status
- Coeliac serology
- Proctoscopy (Proctoscopy is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope, although the latter may be a bit longer) is used to examine the anal cavity, rectum, or sigmoid colon)
- Sigmoidoscopy
Colonoscopy
What is The fecal occult blood test (FOBT)?
It is used to detect microscopic blood in the stool and is a screening tool for colorectal cancer
What deos PR stand for?
Per rectum
What are the causes of constipation?
Systemic
Neurogenic
Organic
Functional
What are the organic causes of constipation?
Strictures
Tumours
Diverticular disease (muscle spasm in the colon)
Proctitis (inflammation of the rectum and anus)
Anal fissure - a small tear in the thin, moist tissue (mucosa) that lines the anus
What are the functional causes of constipation?
Megacolon (Megacolon is an abnormal dilation of the colon. The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel.
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
What are 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 clinical features of IBS?
Abdominal pain
Altered bowel habit
Abdominal bloating
Belchinf wind and flatus
Mucus
What is the prevalence of IBS?
10.5%
What is the NICE diagnostic IBS criteria?
Abdominal discomfort/pain relieved by defaecation or associated with altered stool frequency
Plus 2 or more from:
Altered stool passage
Abdominal bloating
Symptoms made worse by eating
Passage of mucus
Where does pain often radiate to?
Lower back
What suggests that IBS may be as a result of bowel distension?
Pain can be replicated by balloon inflation
When is abdominal pain in IBS less likely to occur?
At night
What is the altered bowel habit of someone with IBS?
Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability
Urgency
What are the findings for examination for someone with IBS?
Normal
What are the relevant investiagtions for IBS?
Blood analysis:
- FBC
- U & E, LFTs, Ca
- CRP
- TFTs (thyroid function tests)
- Coeliac serology
Stool Culture
Calprotectin
Rectal examination and FOB
Colonoscopy?
What is the difference between IBS and IBD? How do we differentiate?
What is the treatment for IBS?
Education and reassurance
Dietic review:
Try removing, tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP
What is the drug therapy for the a) pain b) bloating c) constipation and d)diarrhoea associated with IBS
a) Antipasmotics, Linaclotide
b) Probiotics, Linclatodide - avoid bulking agents and fibre
c) Laxitives, bulking agents / fibre, osmotics, linaclotide, avoid FODMAP
d) Antimotility agents, FODMAP
What are the potential psychological interventions?
Relaxation training (muscle relaxation, biofeedback and meditation
Hypnotherapy (induced state of deep relaxation)
Cognitive behavioural therapy (Identifying symptom triggers and learning to respond more appropriately)
Psychodynamic interpersonal therapy (helping the patient understand how emotions and bowel symptoms inter relate)
What causes IBS?
Altered motility
Visceral Hypersensitivity
Stress, anxiety and depression
What are the bowel contractions like in IBS D and IBS C?
D - muscular contractions may be stronger and more frequent than normal
C - contractions may be reduced
What causes contractions?
Waking and eating - in IBS the response to these normal triggers may be altered
What does it mean ‘the brain hears the gut too loudly in IBS’?
Messages from the gut to the stomach are sent such as hunger or the urge to go to the toilet, In IBS the brain hears these messages too loudly
What is the effect of heightened gut awareness?
People with IBS often have an excessive awareness of normal digestive processes
What is the effect of stress on IBS?
The gut is more sensitive to stress and this can become chronic
