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Functinal GI Disorders Flashcards

1
Q

What are the two broad categories of functinoal GI disorders?

A

Structural

Functional

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2
Q

Define what is meant by a structural disorder?

A

Detectable pathology

  • Macroscopic e.g. a Cancer
  • Microscopic e.g. Colitis
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3
Q

What is meant by a functional disorder?

A

lNo detectable pathology

lRelated to gut function

l“Software faults”

Long-term prognosis good

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4
Q

What are examples of functional GI disorders?

A

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

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5
Q

What is meant by non-ulcer dyspepsia?

A

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
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6
Q

What is the diagnosis of non ulcer dyspepsia?

A
  • 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

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7
Q

What causes retching?

A

Contraction of antrum, closed glottis

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8
Q

What is the cause of vomiting immediately after food?

A

Psychogenic

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9
Q

What is the cause of vomiting 1 hour or more after food?

A
  • Pyloric obstruction
  • Motility disorders including:

Diabetes

Post gastrectomy

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10
Q

What is the cause of spewing 12 hours after eating?

A

Obstruction

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11
Q

What are the functional causes of vomiting?

A

Drugs

Pregnancy

Migraine

Cyclical vomiting syndrome

Alcohol

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12
Q

What are the functional diseases of the lower GI tract?

A

IBS

Slow transit Constipation

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13
Q

What might a patient consider constipation?

A

“Hard stool”

“Incomplete evacuation”

“Difficult evacuation”

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14
Q

What are alarm symptoms?

A
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15
Q

What are the investigations for functional disorders of the lower GI tract?

A

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

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16
Q

What is The fecal occult blood test (FOBT)?

A

It is used to detect microscopic blood in the stool and is a screening tool for colorectal cancer

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17
Q

What deos PR stand for?

A

Per rectum

18
Q

What are the causes of constipation?

A

Systemic

Neurogenic

Organic

Functional

19
Q

What are the organic causes of constipation?

A

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

20
Q

What are the functional causes of constipation?

A

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

21
Q

What are systemic causes of constipation?

A

Diabetes mellitus

Hypothyroidism

Hypercalcaemia

22
Q

What are the neurogenic causes of constipation?

A

Autonomic neuropathies

Parkinson’s disease

Strokes

Multiple sclerosis

Spina bifida

23
Q

What are clinical features of IBS?

A

Abdominal pain

Altered bowel habit

Abdominal bloating

Belchinf wind and flatus

Mucus

24
Q

What is the prevalence of IBS?

25
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
26
Where does pain often radiate to?
Lower back
27
What suggests that IBS may be as a result of bowel distension?
Pain can be replicated by balloon inflation
28
When is abdominal pain in IBS less likely to occur?
At night
29
What is the altered bowel habit of someone with IBS?
Constipation (IBS-C) Diarrhoea (IBS-D) Both diarrhoea and constipation (IBS-M) Variability Urgency
30
What are the findings for examination for someone with IBS?
Normal
31
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?_
32
What is the difference between IBS and IBD? How do we differentiate?
33
What is the treatment for IBS?
Education and reassurance Dietic review: Try removing, tea, coffee, alcohol, sweetener Lactose, gluten exclusion trial FODMAP
34
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
35
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)
36
What causes IBS?
Altered motility Visceral Hypersensitivity Stress, anxiety and depression
37
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
38
What causes contractions?
Waking and eating - in IBS the response to these normal triggers may be altered
39
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
40
What is the effect of heightened gut awareness?
People with IBS often have an excessive awareness of normal digestive processes
41
What is the effect of stress on IBS?
The gut is more sensitive to stress and this can become chronic

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