Functional Bowel Disorders Flashcards
What is the basic feature of functional bowel disorders?
Pain or discomfort referred to the GI tract with altered bowel function
When does bowel function become abnormal?
When it is abnormal for the specific patient and is causing symptoms
Why can functional bowel disorders be difficult to detect and diagnose?
They have no/very little detectable pathology
Give 4 examples of functional bowel disorders
Oesophageal spasm Non-ulcer dyspepsia Biliary dyskinesia Irritable bowel syndrome Slow transit constipation Drug related
If vomiting occurs immediately after eating, what is the cause likely to be?
Psychogenic
If vomiting occurs 1 hour or more after eating, what is the cause likely to be?
Pyloric obstruction or motility disorders
If vomiting occurs 12 or more hours after eating what is the cause likely to be?
Obstruction
Give the causes of functional bowel disorders
Drugs Pregnancy Migraine Cyclical vomiting syndrome Alcohol
What lab investigations might be done in functional bowel disorders?
FBC Blood glucose U&Es LFTs Ca CRP Stool culture Calprotectin Thyroid status Coeliac serology
What imaging investigations might be done in functional bowel disorders?
Proctoscopy
Sigmoidoscopy
Endoscopy
Colonoscopy
How should non-ulcer dyspepsia be treated if H. pylori and other investigations are negative?
Symptomatically
What are the classes of causes constipation?
Systemic
Neurogenic
Organic
Functional
Give an example of a systemic cause of constipation
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
Give an example of a neurogenic cause of constipation
Autonomic neuropathies Parkinson's disease Stroke MS Spina bifida
Give an example of an organic cause of constipation
Strictures Tumours Diverticular disease Proctitis Anal fissure
Give an example of a functional cause of constipation
Megacolon Idiopathic constipation Depression Psychosis Institutionalisation/Admission (due to decreased mobility)
Give an example of how functional bowel disorders can cause psychological factors
Huge impact on quality of life
Major cause of work absences
Affects ability to do normal day-to-day tasks
Can cause incontinence
What do alarm symptoms suggest?
Severe disease and need for further investigation
Give examples of alarm symptoms
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Melaena/ Haematemesis Swallowing difficulty Vomiting Age > 50 Rectal bleeding Abdominal mass
What is nausea?
The sensation of feeling sick
When should treatment for functional bowel disorders be started?
After a firm diagnosis has been reached
What drug therapy can be given for pain in functional bowel disorders?
Antispasmotics
Linaclotide
Antidepressants
What drug therapy can be given for bloating in functional bowel disorders?
Some probiotics
Linaclotide
What drug therapy can be given for constipation in functional bowel disorders?
Laxatives
Linaclotide
Softeners
Osmotics
What drug therapy can be given for diarrhoea in functional bowel disorders?
Anti motility agents
FODMAP diet
What psychological intervention can be given in functional bowel disorders?
Relaxation training
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
For what patients is relaxation training most effective?
Patients with diarrhoea or psychological co-morbidity
For what patients is hypnotherapy most effective?
Refractory patients
For what patients is cognitive behavioural therapy not effective?
Patients with depression or patients who believe that the cause of their symptoms is physical
For what patients if psychodynamic interpersonal therapy most effective?
In patients with a history of abuse
