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Systems: Alimentary AB > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What are the 2 broad categories of GI disease?

A
  • Structural

- Functional

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2
Q

Describe a structural GI disorder.

A
  • Detectable pathology: macroscopic/microscopic
  • Usually both
  • Prognosis depends on pathology
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3
Q

Describe a functional GI disorder.

A
  • No detectable pathology
  • Related to gut function
  • “Software” faults
  • Long-term prognosis good
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4
Q

Give 6 examples of functional GI disorders.

A
  • Oesophageal spasm
  • Non-ulcer dyspepsia
  • Biliary dyskinesia
  • Irritable bowel syndrome
  • Slow transit constipation
  • Drug related effects
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5
Q

What are functional GI disorders responsible for?

A
  • Initial and return consultations
  • Large impact on quality of life
  • Work absence
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6
Q

How can a large majority of functional GI disorders be diagnosed?

A

History and examination

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7
Q

Other than physical , what other factors are important with functional GI disorders?

A

Psychological

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8
Q

What are functional GI disorders not associated with?

A

Development of serious pathology

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9
Q

What type of pain is experienced with non-ulcer dyspepsia?

A

Dyspeptic pain

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10
Q

What is found on investigation of non-ulcer dyspepsia?

A
  • No ulcer on endoscopy

- H pylori status varies

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11
Q

What possibly contributes to non-ulcer dyspepsia?

A
  • Reflux
  • Low grade duodenal ulceration
  • Delayed gastric emptying
  • Irritable bowel syndrome
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12
Q

How is a diagnosis of non-ulcer dyspepsia made?

A
  • History + examination
  • H pylori status
  • Alarm symptoms
  • If all negative then treat symptomatically
  • If H pylori positive then eradication therapy
  • If in doubt then endoscopy
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13
Q

Nausea

A

The sensation of feeling sick

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14
Q

Retching

A
  • Dry heaves

- Antrum contracts, glottis closed

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15
Q

Vomiting

A

Contents expelled

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16
Q

What neural control is responsible for vomiting?

A
  • Sympathetic and vagal components
  • Vomiting centre (may not exist as entity)
  • Chemoreceptor Trigger Zone
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17
Q

What may stimulate the CTZ?

A
  • Opiates
  • Digoxin
  • Chemotherapy
  • Uraemia
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18
Q

What is important to note in the history of vomiting?

A

-Length of time after food ingested

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19
Q

What could immediate vomiting after food suggest?

A

Psychogenic

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20
Q

What could vomiting 1 hour or more after ingestion of food suggest?

A
  • Pyloric obstruction

- Motility disorders such as diabetes or post gastrectomy

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21
Q

What could vomiting 12 hours after ingestion of food suggest?

A

Obstruction

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22
Q

What are functional causes of vomiting?

A
  • Drugs
  • Pregnancy
  • Migraine
  • Cyclical vomiting syndrome
  • Alcohol
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23
Q

What is cyclical vomiting syndrome?

A
  • Onset in childhood

- Recurrent episodes 2-3 x a year for 2-3 times a month

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24
Q

Describe psychogenic vomiting?

A
  • Often young women
  • Often for years
  • May have no nausea
  • May be self induced
  • Appetite undisturbed
  • May lose weight
  • Often stops shortly after admission
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25
Q

Name 2 functional diseases of the lower GIT?

A
  • IBS

- Slow transit constipation

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26
Q

What is normal bowel habit?

A
  • Varies greatly so no definitive normal

- Whatever is normal for the patient is their normal

27
Q

What are the 2 ends of the Bristol stool chart?

A
  • Type 1 pellets

- Type 7 watery with no solids

28
Q

What should be included in examination for lower GIT?

A
  • Evidence of systemic disease
  • Abdominal examination
  • Rectal examination
  • FOB
29
Q

What are the alarm symptoms?

A
  • > 50 years old
  • Short symptom history
  • Unintentional weight loss
  • Nocturnal symptoms
  • Male
  • Family history
  • Anaemic
  • Rectal bleeding
  • Recent antibiotic use
  • Abdominal mass
30
Q

What investigations should be carried out for lower GIT?

A
  • FBC
  • Blood glucose
  • U+Es
  • Thyroid function
  • Coeliac serology
  • Protoscopy
  • Sigmoidoscopy
  • Colonoscopy
31
Q

What are the types of aetiology for constipation?

A
  • Systemic
  • Neurogenic
  • Organic
  • Functional
32
Q

Give 5 organic causes of constipation.

A
  • Strictures
  • Tumours
  • Diverticular disease
  • Proctitis
  • Anal fissure
33
Q

Give 5 functional causes of constipation.

A
  • Megacolon
  • Idiopathic constipation
  • Depression
  • Psychosis
  • Institutionalised patients
34
Q

Give 3 systemic causes of constipation.

A
  • Diabetes mellitus
  • Hypothyroidism
  • Hypercalcaemia
35
Q

Give 5 neurogenic causes of constipation.

A
  • Autonomic neuropathies
  • Parkinson’s disease
  • Strokes
  • Multiple sclerosis
  • Spina bifida
36
Q

What are 5 clinical features of IBS?

A
  • Abdominal pain
  • Altered bowel habit
  • Abdominal bloating
  • Belching wind and flatus
  • Mucus
37
Q

Give 5 ways in which abdominal pain could be described?

A
  • Vague
  • Bloating
  • Burning
  • Sharp
  • Colicky
38
Q

How can abdominal pain radiate?

A

To the lower back

39
Q

What may abdominal pain be due to?

A

Bowel distension

40
Q

What can alter abdominal pain?

A

Bowel action

41
Q

What are the 2 types of IBS?

A
  • Constipation predominant

- Diarrhoea predominant

42
Q

What are the features of altered bowel habit in IBS?

A
  • Constipation (IBS-C)
  • Diarrhoea (IBS-D)
  • Diarrhoea and constipation (IBS-M)
  • Variability
  • Urgency
43
Q

What may bloating be due to?

A
  • Wind and flatulence

- Relaxation of abdominal wall muscles

44
Q

What must be true for a diagnosis of IBS?

A
  • A compatible history

- Normal physical examination

45
Q

What blood analysis would be carried out when investigating for IBS?

A
  • FBC
  • U+Es
  • Ca
  • CRP
  • TFT
  • Coeliac serology
46
Q

What investigations would be carried out for IBS?

A
  • Stool culture
  • Calprotectin
  • Rectal examination and FOB
  • Colonoscopy
47
Q

What is calprotectin?

A
  • Calprotectin is released by inflamed gut mucosa

- It is used to differentiate IBS from IBD and for monitoring IBD

48
Q

What is the treatment for IBS?

A
  • Education and reassurance

- Dietetic review

49
Q

What are 4 common causes of diarrhoea?

A
  • Tea
  • Coffee
  • Alcohol
  • Sweetners
50
Q

What can drug products help to relieve in IBS?

A
  • Pain
  • Bloating
  • Constipation
  • Diarrhoea
51
Q

What psychological interventions are there for IBS?

A
  • Relaxation therapy
  • Hypnotherapy
  • Cognitive behavioural therapy
  • Psychodynamic interpersonal therapy
52
Q

What can cause IBS?

A
  • Altered motility
  • Visceral hypersensitivity
  • Stress, anxiety, depression
53
Q

What is the bowel?

A

A muscular tube that squeezes content from one end to the other

54
Q

What happens to bowel in IBS-D?

A

Muscular contractions may be stronger

55
Q

What happens in IBS-C?

A

Muscular contractions may be reduced

56
Q

What can trigger contractions of the gut?

A

Waking and eating

57
Q

How might the gut respond to triggers in IBS-D?

A

Stronger

58
Q

How might the gut respond to triggers in IBS-C?

A

Reduced response

59
Q

What messages can the brain receive from the gut?

A
  • Hunger

- Urge to go toilet etc

60
Q

How does the brain “hear” messages from the gut in IBS?

A

Too loudly

61
Q

What type of awareness of digestive processes do people with IBS have?

A

Excessive awareness

62
Q

What is the biopsychosocial link in IBS?

A

-Psychological influences, early life and psychological influences act on the brain-gut axis = IBS outcomes

63
Q

How does the stress response become chronic?

A

In IBS the gut is more sensitive to stress

Systems: Alimentary AB (37 decks)

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