Functional Bowel Disorders Flashcards
What are the 2 broad categories of GI disease?
- Structural
- Functional
Describe a structural GI disorder.
- Detectable pathology: macroscopic/microscopic
- Usually both
- Prognosis depends on pathology
Describe a functional GI disorder.
- No detectable pathology
- Related to gut function
- “Software” faults
- Long-term prognosis good
Give 6 examples of functional GI disorders.
- Oesophageal spasm
- Non-ulcer dyspepsia
- Biliary dyskinesia
- Irritable bowel syndrome
- Slow transit constipation
- Drug related effects
What are functional GI disorders responsible for?
- Initial and return consultations
- Large impact on quality of life
- Work absence
How can a large majority of functional GI disorders be diagnosed?
History and examination
Other than physical , what other factors are important with functional GI disorders?
Psychological
What are functional GI disorders not associated with?
Development of serious pathology
What type of pain is experienced with non-ulcer dyspepsia?
Dyspeptic pain
What is found on investigation of non-ulcer dyspepsia?
- No ulcer on endoscopy
- H pylori status varies
What possibly contributes to non-ulcer dyspepsia?
- Reflux
- Low grade duodenal ulceration
- Delayed gastric emptying
- Irritable bowel syndrome
How is a diagnosis of non-ulcer dyspepsia made?
- 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
Nausea
The sensation of feeling sick
Retching
- Dry heaves
- Antrum contracts, glottis closed
Vomiting
Contents expelled
What neural control is responsible for vomiting?
- Sympathetic and vagal components
- Vomiting centre (may not exist as entity)
- Chemoreceptor Trigger Zone
What may stimulate the CTZ?
- Opiates
- Digoxin
- Chemotherapy
- Uraemia
What is important to note in the history of vomiting?
-Length of time after food ingested
What could immediate vomiting after food suggest?
Psychogenic
What could vomiting 1 hour or more after ingestion of food suggest?
- Pyloric obstruction
- Motility disorders such as diabetes or post gastrectomy
What could vomiting 12 hours after ingestion of food suggest?
Obstruction
What are functional causes of vomiting?
- Drugs
- Pregnancy
- Migraine
- Cyclical vomiting syndrome
- Alcohol
What is cyclical vomiting syndrome?
- Onset in childhood
- Recurrent episodes 2-3 x a year for 2-3 times a month
Describe psychogenic vomiting?
- Often young women
- Often for years
- May have no nausea
- May be self induced
- Appetite undisturbed
- May lose weight
- Often stops shortly after admission
Name 2 functional diseases of the lower GIT?
- IBS
- Slow transit constipation
What is normal bowel habit?
- Varies greatly so no definitive normal
- Whatever is normal for the patient is their normal
What are the 2 ends of the Bristol stool chart?
- Type 1 pellets
- Type 7 watery with no solids
What should be included in examination for lower GIT?
- Evidence of systemic disease
- Abdominal examination
- Rectal examination
- FOB
What are the alarm symptoms?
- > 50 years old
- Short symptom history
- Unintentional weight loss
- Nocturnal symptoms
- Male
- Family history
- Anaemic
- Rectal bleeding
- Recent antibiotic use
- Abdominal mass
What investigations should be carried out for lower GIT?
- FBC
- Blood glucose
- U+Es
- Thyroid function
- Coeliac serology
- Protoscopy
- Sigmoidoscopy
- Colonoscopy
What are the types of aetiology for constipation?
- Systemic
- Neurogenic
- Organic
- Functional
Give 5 organic causes of constipation.
- Strictures
- Tumours
- Diverticular disease
- Proctitis
- Anal fissure
Give 5 functional causes of constipation.
- Megacolon
- Idiopathic constipation
- Depression
- Psychosis
- Institutionalised patients
Give 3 systemic causes of constipation.
- Diabetes mellitus
- Hypothyroidism
- Hypercalcaemia
Give 5 neurogenic causes of constipation.
- Autonomic neuropathies
- Parkinson’s disease
- Strokes
- Multiple sclerosis
- Spina bifida
What are 5 clinical features of IBS?
- Abdominal pain
- Altered bowel habit
- Abdominal bloating
- Belching wind and flatus
- Mucus
Give 5 ways in which abdominal pain could be described?
- Vague
- Bloating
- Burning
- Sharp
- Colicky
How can abdominal pain radiate?
To the lower back
What may abdominal pain be due to?
Bowel distension
What can alter abdominal pain?
Bowel action
What are the 2 types of IBS?
- Constipation predominant
- Diarrhoea predominant
What are the features of altered bowel habit in IBS?
- Constipation (IBS-C)
- Diarrhoea (IBS-D)
- Diarrhoea and constipation (IBS-M)
- Variability
- Urgency
What may bloating be due to?
- Wind and flatulence
- Relaxation of abdominal wall muscles
What must be true for a diagnosis of IBS?
- A compatible history
- Normal physical examination
What blood analysis would be carried out when investigating for IBS?
- FBC
- U+Es
- Ca
- CRP
- TFT
- Coeliac serology
What investigations would be carried out for IBS?
- Stool culture
- Calprotectin
- Rectal examination and FOB
- Colonoscopy
What is calprotectin?
- Calprotectin is released by inflamed gut mucosa
- It is used to differentiate IBS from IBD and for monitoring IBD
What is the treatment for IBS?
- Education and reassurance
- Dietetic review
What are 4 common causes of diarrhoea?
- Tea
- Coffee
- Alcohol
- Sweetners
What can drug products help to relieve in IBS?
- Pain
- Bloating
- Constipation
- Diarrhoea
What psychological interventions are there for IBS?
- Relaxation therapy
- Hypnotherapy
- Cognitive behavioural therapy
- Psychodynamic interpersonal therapy
What can cause IBS?
- Altered motility
- Visceral hypersensitivity
- Stress, anxiety, depression
What is the bowel?
A muscular tube that squeezes content from one end to the other
What happens to bowel in IBS-D?
Muscular contractions may be stronger
What happens in IBS-C?
Muscular contractions may be reduced
What can trigger contractions of the gut?
Waking and eating
How might the gut respond to triggers in IBS-D?
Stronger
How might the gut respond to triggers in IBS-C?
Reduced response
What messages can the brain receive from the gut?
- Hunger
- Urge to go toilet etc
How does the brain “hear” messages from the gut in IBS?
Too loudly
What type of awareness of digestive processes do people with IBS have?
Excessive awareness
What is the biopsychosocial link in IBS?
-Psychological influences, early life and psychological influences act on the brain-gut axis = IBS outcomes
How does the stress response become chronic?
In IBS the gut is more sensitive to stress
