Functional Bowel Disorders Flashcards
What is a functional GI disease?
No detectable pathology, that are related to gut function and they have good long-term prognosis Software faults
What is a structural GI disease?
Detectable pathology e.g. Macroscopic - Cancer or Microscopic - Colitis
What are different types of functional GI disorders?
Oesophageal spasm Non-Ulcer Dysplasia Biliary Dyskinesia Irritable Bowel Syndrome Slow transit constipation Drug related effects
What does biliary dyskinesia affect?
Gallbladder and Sphincter of oddi
Does a structural or functional GI disease have a bigger effect on a patients quality of life?
Functional but they can be diagnosed with history and examination
What is Non-Ulcer Dyspepsia (NUD)?
Dyspeptic type pain with no ulcer on endoscopy as the H. pylori status varies
How do you diagnose NUD?
Check family history
H. pylori status - Negative = Treat symptoms & Positive = Eradication therapy
Possible endoscopy
What is nausea?
The sensation of feeling sick
What is retching?
Dry heave with the antrum contracting but the glottis remaining closed
What is vomiting?
Contents expelled
What do the times of when you have been sick tell you about the cause of it?
Immediately - Psychogenic
1 hour or more - Pyloric obstruction/Motility disorder
12 hours - Obstruction (further down bowel)
What are the causes of vomiting?
Drugs Pregnancy Alcohol Migraine Cyclical Vomiting Syndrome
When is pyschogenic vomiting often seen?
Often in young women who have no preceding nausea Can be self-induced and doesn’t affect appetite
What are features of IBS?
Altered bowel habit - Constipation? Diarrhoea? Urgency? Abdominal pain Abdominal bloating Belching wind Flatus Mucus
What is the criteria for IBS?
3 months of abdominal pain:
Relieved by defaecation
Associated change of consistency and frequency
AND 2 or more:
Altered stool frequency/form/passage
Passage of mucus
Bloating
What are the causes of IBS?
Altered motility
Visceral hypersensitivity
Stress, Anxiety & Depression
What are the investigations of IBS?
Blood analysis Stool culture Faecal calprotectin Rectal examination Colonoscopy if in doubt
What does calprotectin show?
Protein released by inflamed mucosa and is detected in the stool so can differentiate between IBS & IBD
Will be raised in bowel cancer
What is the treatment for IBS?
Education and reassurance
Dietetic review
How do muscular contractions compare for constipation and diarrhoea in IBS patients?
Constipation - Contraction may be reduced
Diarrhoea - Stronger and more frequent contractions
What do people with IBS often have?
Heightened awarenes of normal digestive processes
What does the brain receive in IBS?
Too strong a signal from the gut telling it is hungry/has a toilet urge
What do you look for on examination in a patient with a functional bowel disorder?
Look for systemic disease
Careful abdominal examination
Rectal examination
FOB
What investigations do you for a patient with a functional bowel disorder?
FBC & U+E's Glucose Thyroid status - Hypothyroid can cause constipation Coeliac serology Proctoscopy & Sigmoidoscopy
What is the aetiology of constipation plus an example?
Systemic - Widespread issue e.g. Diabetes
Neurogenic - Brain is causing this e.g. Stroke, MS or Spina Bifida
Organic - Something is physically wrong e.g. Tumour or Anal fissure
Functional - Something just isn’t working right e.g. Depression, Psychosis or a Megacolon
What is a megacolon?
An abnormal dilation of the colon
What pyschological factors play a role in GI disease?
Anorexia
Bulimia
Butterflies and diarrhoea in response to stress
In IBS the gut is more sensitive to stress - Response can become chronic
