Functional bowel disorders Flashcards
What are functional bowel disorders?
Functional bowel disorders occur when all of the organs are normal, but there are still signs that something is wrong.
What are some common symptoms of functional bowel disease in the upper GI tract and lower GI tract?
Upper gastrointestinal (GI) symptoms include: nausea, feeling bloated, and stomach pain.
Lower GI symptoms include:
constipation, diarrhea, and stomach pain.
Why is it hard to diagnose functional bowel disorders?
Because there is no pathology or structural or tissue abnormalities it means there is no diagnostic test or definitive way to diagnose them and so they are largely diagnosed by a “process of elimination” by ruling out possible other GI disease causes.
What is the name of the criteria used for diagnosis of all functional bowel disorders?
Rome criteria
What are some “red flags” that should indicate to you someone dosent have a functional bowel disorder?
Iron deficiency, anaemia, weight loss, bleeding, night diarrhoea (nocturnal diarrhoea), family history of colon cancer, vomiting, a very short history/fast onset of symptoms (IBS is a chronic problem not acute)
What is the most common functional bowel disorder in the bowel (small/large intestine)?
Irritable bowel syndrome
What are some common symptoms of IBS?
Swinging of bowel habits (switching between constipation and diarrhoea)
Abdo pain relieved with defaecation
Other symptoms include: urgency to poo, bloating, gas, feeling of incomplete pooping evacuation
At what age does IBS tend to occur?
Tends to occur in young adults (20 year olds) hence adults over 40 is quite concerning and their diagnoses should be reconsidered
What are the two main theories for the cause/pathophysiology of the disease?
Altered gut motility
- (either two fast/exaggerated or too slow/reduced hence the symptom of swinging between diarrhoea and constipation).
Visceral hypersensitivity
- more sensitive to pain compared to the average person eg a baloon that distend colon causes pain in over 50% of patients with IBS compared to only in 10% of those without
What is the difference between peripheral sensitisation and central sensitisation? (as causes for IBS)
Peripheral sensitivity refers to the increased sensitivity and pain in the gut and central sensitivity refers to the sensitivity and pain that has spread to other areas of the body hence why headaches and back pain are related symptoms to IBS.
What are some of the conventional treatments for IBS?
Fibre supplements - to decrease bloating/constipation
Laxatives
Low dose anti-depressants for pain
Anti-motility drugs for bowel frequency
What theory is the FODMAPs diet as a form of dietary treatment for IBS based on?
The idea that there are certain saccharides that can cause excessive fermentation and therefore cause symptoms. Removal of these foods may help decrease symptoms.
What is the main component of natural treatment for IBS?
Probiotics
What is some advice given as part of lifestyle treatment for IBS?
Have regular meals
Get adequate sleep
Reduce stress levels
What are the two main diseases of inflammatory bowel disease?
Ulcerative colitis and Crohns disease
Is there a genetic basis to IBD?
It is likely that there is a genetic component to IBD as first degree relatives are more likely to have IBD. However there are many genes involved so it is not completely known.
What is the proposed theory/pathophysiology as to what the cause of IBD is?
It is thought that there is a disruption of the epithelial barrier in the intestines which leads to an abnormal immune response.
Where in the intestines does ulcerative colitis occur?
Only in the colon
Is the inflammation caused by ulcerative colitis continuous or spread?
Continuous (starting in the rectum and moving proximally)
In ulcerative colitis is ulceration macroscopically visible?
Only in severe cases
How deep into the gut lining does the inflammatin caused by ulcerative colitis go?
Only in the mucosal layer
What are some of the histological features of ulcerative colitis?
There is distortion of the crypts - they should occur as singular structures but sometimes abnormal branching can be seen
Crypt abscess’s can also be seen as neutrophils invade the crypts and from clusters
What are some of the clinical symptoms that ulcerative colitis presents with?
Diarrhoea with blood
Abdo discomfort
Fever, malaise (general unwellness) and potentially weight loss
What will the result of a blood test show?
Raised neutrophils - due to inflammatory response
Mild anaemia - however the ferritin levels will be raised as this occurs with any inflammatory response. If bleeding prolongs then eventually will lead to low ferritin (iron deficiency.
What is toxic megacolon?
A complication of ulcerative colitis where the colon becomes very dilated. This can be observed/measured on a general xray.
Where in the GI tract does crohns disease occur?
Any part (from mouth to anus) although it commonly occurs in the ileum and colon.
Is the imflammation cause by crohns disease continuous of pathcy?
It is discontinuous. It occurs in patches.
How deep into the gut wall does the inflammation from crohns disease go?
It occurs throughout the entire thickness of the wall (not just the mucosa). This is called transmural inflammation.
What is the progression in appearance of the gut wall as crohns disease worsens? (start at small ulcers on the mucosa)
- Small ulcers on the mucusa
- progresses to deep penetrating ulcers with fissuring in between
- at a severe stage there is a “cobblestone” appearance as the areas between the ulcers are swollen
What is the histological appearance of crohns disease?
Transmural inflammation (goes entire depth of gut wall)
Granulomas (clusters of inflammation made up of giant cells)
What subgroups is crohns disease divided into when being examined clinically?
Inflammatory, fistulising, stricturing, perianal
What are the symptoms of inflammatory crohns disease in the stomach/duodenum, ileum and colon?
Stomach/duodenum (gastritis//duodenitis) - results in dyspepsia (indigestion)
Ileum (ileitis) - results in abdo pain and some malabsoprtion (eg bile malabsorption so results in steatorhoea)
Colon (colitis) - results in similar symptoms to ulcerative colitis (diarrhoea with blood)
What is the treatment for IBD in general?
Anti inflammatory drugs eg 5-ASA (5-aminosalicylates)
Steroids
Immuno-suppressants
If none of these help then the next option is surgery to resect the diseased bowel (eg colectomy)
What are the main similarities and differences between IBS and IBD?
IBS = quite common, main symptoms are “swinging” bowel disease
IBD = much less common, main symptoms are diarrhoea and bleeding
