Functional bowel disorders

Question 1

What are functional bowel disorders?

Answer 1

Functional bowel disorders occur when all of the organs are normal, but there are still signs that something is wrong.

Question 2

What are some common symptoms of functional bowel disease in the upper GI tract and lower GI tract?

Answer 2

Upper gastrointestinal (GI) symptoms include:
nausea, feeling bloated, and stomach pain. 

Lower GI symptoms include:
constipation, diarrhea, and stomach pain.

Question 3

Why is it hard to diagnose functional bowel disorders?

Answer 3

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.

Question 4

What is the name of the criteria used for diagnosis of all functional bowel disorders?

Answer 4

Rome criteria

Question 5

What are some “red flags” that should indicate to you someone dosent have a functional bowel disorder?

Answer 5

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)

Question 6

What is the most common functional bowel disorder in the bowel (small/large intestine)?

Answer 6

Irritable bowel syndrome

Question 7

What are some common symptoms of IBS?

Answer 7

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

Question 8

At what age does IBS tend to occur?

Answer 8

Tends to occur in young adults (20 year olds) hence adults over 40 is quite concerning and their diagnoses should be reconsidered

Question 9

What are the two main theories for the cause/pathophysiology of the disease?

Answer 9

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

Question 10

What is the difference between peripheral sensitisation and central sensitisation? (as causes for IBS)

Answer 10

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.

Question 11

What are some of the conventional treatments for IBS?

Answer 11

Fibre supplements - to decrease bloating/constipation

Laxatives

Low dose anti-depressants for pain

Anti-motility drugs for bowel frequency

Question 12

What theory is the FODMAPs diet as a form of dietary treatment for IBS based on?

Answer 12

The idea that there are certain saccharides that can cause excessive fermentation and therefore cause symptoms. Removal of these foods may help decrease symptoms.

Question 13

What is the main component of natural treatment for IBS?

Answer 13

Probiotics

Question 14

What is some advice given as part of lifestyle treatment for IBS?

Answer 14

Have regular meals
Get adequate sleep
Reduce stress levels

Question 15

What are the two main diseases of inflammatory bowel disease?

Answer 15

Ulcerative colitis and Crohns disease

Question 16

Is there a genetic basis to IBD?

Answer 16

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.

Question 17

What is the proposed theory/pathophysiology as to what the cause of IBD is?

Answer 17

It is thought that there is a disruption of the epithelial barrier in the intestines which leads to an abnormal immune response.

Question 18

Where in the intestines does ulcerative colitis occur?

Answer 18

Only in the colon

Question 19

Is the inflammation caused by ulcerative colitis continuous or spread?

Answer 19

Continuous (starting in the rectum and moving proximally)

Question 20

In ulcerative colitis is ulceration macroscopically visible?

Answer 20

Only in severe cases

Question 21

How deep into the gut lining does the inflammatin caused by ulcerative colitis go?

Answer 21

Only in the mucosal layer

Question 22

What are some of the histological features of ulcerative colitis?

Answer 22

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

Question 23

What are some of the clinical symptoms that ulcerative colitis presents with?

Answer 23

Diarrhoea with blood
Abdo discomfort
Fever, malaise (general unwellness) and potentially weight loss

Question 24

What will the result of a blood test show?

Answer 24

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.

Question 25

What is toxic megacolon?

Answer 25

A complication of ulcerative colitis where the colon becomes very dilated. This can be observed/measured on a general xray.

Question 26

Where in the GI tract does crohns disease occur?

Answer 26

Any part (from mouth to anus) although it commonly occurs in the ileum and colon.

Question 27

Is the imflammation cause by crohns disease continuous of pathcy?

Answer 27

It is discontinuous. It occurs in patches.

Question 28

How deep into the gut wall does the inflammation from crohns disease go?

Answer 28

It occurs throughout the entire thickness of the wall (not just the mucosa). This is called transmural inflammation.

Question 29

What is the progression in appearance of the gut wall as crohns disease worsens? (start at small ulcers on the mucosa)

Answer 29

• 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

Question 30

What is the histological appearance of crohns disease?

Answer 30

Transmural inflammation (goes entire depth of gut wall)

Granulomas (clusters of inflammation made up of giant cells)

Question 31

What subgroups is crohns disease divided into when being examined clinically?

Answer 31

Inflammatory, fistulising, stricturing, perianal

Question 32

What are the symptoms of inflammatory crohns disease in the stomach/duodenum, ileum and colon?

Answer 32

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)

Question 33

What is the treatment for IBD in general?

Answer 33

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)

Question 34

What are the main similarities and differences between IBS and IBD?

Answer 34

IBS = quite common, main symptoms are “swinging” bowel disease

IBD = much less common, main symptoms are diarrhoea and bleeding