Functional Bowel Disorders Flashcards
What is unique about functional bowel disorders?
They do not have a single/ any pathological cause
What are symptoms of IBS? Is there a mucosal abnormality? When does it normally begin?
Swinging/altered bowel habits; abdominal pain (relieved with defecation); bloating, urgency/incomplete invacuation
No there is no mucosal damage
Is chronic, so must have been present for ~6 months
Typically has an early onset (early 20s)
Can there be associated symptoms with IBS?
Yes, backache/headache; poor sleep; urinary symptoms
What are the main points about the pathophysiology of IBS?
Impaired gut motility- frequency of contractions altered, exaggerated response to meal
Visceral hypersensitivity- More sensitive to distension. After gastroenteritis more sensitive (peripheral), or damage to nearby tissues (central)
The brain starts to focus on processing unpleasant -stimuli more- Hypervigilance
What are some treatments for IBS?
Fibre supplements; laxatives; anti motility drugs eg loperamide; low dose antidepressants
What are the two inflammatory bowel disease we discuss?
Crohns disease and ulcerative colitis
What is the link between genetics an IBD?
- First degree relatives are more likely to have IBD
- Many genes involved
- Majority of IBD patients have no family history of it
What is the pathophysiology of IBD?
-Disruption of epithelium as well as dysregulation of immune system leading to inflammation.
Causes can be a mixture of genetic susceptibility, environmental triggers, immune response and microbes
What is the pathology of ulcerative colitis?
Colon inflammation, starting at rectum and going proximally. Inflammation is diffuse and granular, and is only macroscopic in severe disease
What is UC histology?
Crypt cells distorted (branch) and atrophy.
Paneth cell metaplasia
How does UC present clinically?
Bloody diarrhoea; frequent bowel motions; abdominal dicomfort.
Bloods might show high platelets and neutrophils, mild anaemia and low ferritin
What is the pathology of Crohns disease?
Autoimmune, commonly affects ileum and proximal colon.
TRANSMURAL inflammation. Mucosa in severe cases will ‘cobblestone’ as entire gut wall is inflammed
How does crohns present histologically?
Transmural inflammation; non-caesating granulomas
How does crohns present clinically?
Depends on GI tract affected, but-
inflammation; stricturing; fistulas; perianal problems
Inflammatory- blood with diarrhoea, abdominal pain, dyspepsia
Strictures- pain, distension, vommiting
Fistulas- (enterocutaneous, enteroenteric etc)
Perianal- fistulas, abcesses
What is general treatment for IBD?
5-ASA (anti- inflammatory)
Steroids
