Functional bowel disorders Flashcards
What is detectable in an organic bowel disorder?
Organic pathology
Give 2 examples of organic pathology
macroscopic - cancer
microscopic - colitis
What does the prognosis of organic disorders depend on?
the pathology
What are functional bowel disorders related to?
gut function with no underlying pathology
What is the long term prognosis of functional bowel disorders?
good
What are some examples of functional bowel disorders?
oesophageal spasm
IBS, biliary dyskinesia, drug related effects, slow transit constipation, non ulcer dyspepsia
What are very important to consider with functional bowel disorders?
psychological factors
What is non ulcer dyspepsia?
dyspeptic type pain but no ulcer on endoscopy
What are some possible causes or NUD?
microscopic ulceration, reflux, IBS, delayed gastric emptying
If a patient is under 45 what are the 2 important things to check?
H pylori + ALARM
If H pylori is negative what do you treat?
The symptoms eg PPI
If you are in doubt about the diagnosis what should you do?
endoscopy
What is nausea?
The feeling of being sick without actually vomiting
What is retching?
Dry heaves
antrum contracts on a closed glottis
What is vomiting?
Contents expelled
What is the chemoreceptor trigger zone and give examples of stimulators
vomiting centre
chemotherapy, opiates, digoxin, uraemia
Give the 3 time periods of eating and being sick and try and think of what the cause may be?
immediate - psychogenic
1 hour + - pyloric obstruction, motility disorder, diabetes
12 hour - obstruction eg hernia/stricture
What are some functional causes of vomiting?
pregnancy, alcohol, drugs, abdominal migraine, cyclical vomiting syndrome
What is cyclical vomiting syndrome?
childhood onset
2-3 times a month to 2-3 times a year
What is psychogenic cause of vomiting linked with?
bulimia usually young women
What is the normal bowel habit and what specific changes are of note?
normal for you!
change in frequency, consistency, blood, mucus
How are some ways to examine a patient with altered bowel habits?
rectal examination
ask with relation to Bristol stool chart
family history
physical examination
There are 10 ALARM symptoms - name as many as you can
over 50, male, rectal bleeding, unintentional weight loss, recent onset, mass, anaemia, family history, recent antibiotic use, nocturnal symptoms
What are some investigations you would do in altered bowel habits patient?
FBC, U+E’s, thyroid, blood glucose, coeliac serology
sigmoidoscopy, proctoscopy and colonoscopy in IBD
What are some systemic causes of constipation?
diabetes, hypothyroidism, hypercalcaemia
What are some functional causes of constipation?
depression, idiopathic, megacolon
What are some organic causes of constipation?
tumours, strictures, anal fissure, diverticular disease
What are some neurogenic causes of constipation?
parkinsons, spinal injury, stroke
List some symptoms of IBS
bloating, wind/flatus, abdominal pain radiating to the lower back, altered bowel habit, rectal bleeding, improvement after defaecation, urgency
What are the 3 types of IBS
IBS-C constipation
IBS-D diarrhoea
IBS-M both
What are people with IBS more aware of?
Their digestive system
What is the difference between IBS-c and IBS-d?
D - more harder contractions, hears the brain messages too loudly and is over responsive
What is calprotectin and what is it used for in relation to IBS?
Released by inflamed gut mucosa
differentiate IBS+IBD and to monitor IBD
What are some non drug treatments of IBS?
dietetic review eg FODMAP and reintroduction
hypnotherapy and relaxation
What medications are used for the pain, bloating, IBS-C and IBS-D?
pain - antispasmodics and antidepressants
bloating - probiotics
C - laxatives, fibres, osmotics
D - antimotility drugs and FODMAP
