Functional Bowel Disorders Flashcards
What is the two categories of GI diseases
Structutal
Functional
What is the features of structural GI diseases
Detectable Pathology
Usual affects function
Prognosis depends on pathology
What is the features of functional GI diseases
No detectable pathology
Related to gut function
Long-term prognosis good
psychological factors important
What are six examples of functional GI disorders
Oesophageal spasm
Non-Ulcer Dyspepsia - symptoms without ulcers
Biliary Dyskinesia
Irritable Bowel syndrome
Slow Transit Constipation
Drug Related Effects
Define Biliary Dyskinesia
Bile cannot properly move in the proper direction through tubular glands
What other diseases is non ulcer dyspepsia accosiated with
Reflux
Low grade duodenal ulceration
Delayed gastric emptying
Irritable bowel syndrome
What is investigated in Non ulcer Dyspepsia
Because the the presence of no ulcers with dyspeptic type pain the H. Pylor status is investigated
(as well as gastric cancer caused by H.pylori)
How is Non ulcer dyspepsia investigated
Endoscopy
How do you treat non ulcer dyspepsia
H.pylori negative and no alarm symptoms- treat acid suppression e.g. omeprazole
H.Pylor postive - Eradication
Define:
- Nausea
- Retching
- Vomiting
- Sensation of feeling sick
- Dry heaves
- Contents expelled
What is the mechanism of retching
Antrum contracts while glottis is closed so nothing is expelled
Vommiting has both sympathetic and vagal components what receptors do these act upon
Vomiting centre
Chemoreceptor trigger zone Receptors for opiates Digoxin Chemotherapy Uraemia
What causes you to vomit food immediately/ 1 hour after/12 hours after
Immediately:
psychogenic factor
> 1Hr:
-Pyloric obstruction
-Motility disorders (diabetes,
post gastrectomy)
12hrs:
Obstruction
What is functional causes of vomiting
Drugs
Pregnancy
Migraine
- causes abdominal pain
Cyclical Vomiting Syndrome (recurrent attacks)
Alcohol
What is the features of psychogenic vomiting
Happens with no preceding nausea
- potentially self induced
- appetite usually not disturbed
- may lose weight
What are the two specific functional disease of the Lower GI tract
Irritable bowel syndrome
slow transit constipation
What questions are asked in History taking of abnormal gut function
What is normal to the patients
- Change in frequency
- Blood in stool
- Mucus in stool
What are the alarm symptoms of bowel function problems
Over 50 years
Short symptomatic history
unintentional weight loss
Nocturnal symptoms
Family history of bowel/ovarian cancer
Anemia
rectal bleeding
Recent antibiotic use
Males (report less)
Abdominal Mass
What are the investigations used when assessing bowel function problems
FBC
Blood glucose
U + E,
Thyroid status
Coeliac serology
Proctoscopy - examine anus
Sigmoidoscopy - examine sigmoid by
Colonoscopy
What is the 4 category aetiology of constipation
Systemic
Neurological
Organic
Functional
What is the causes or organic constipation
Strictures Tumours Diverticular disease Proctitis Anal fissure
What is the causes or Functional constipation
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
What is the cause of systemic constipation
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What is the causes of neurological constipation
Autonomic neuropathies Parkinson's disease Strokes Multiple sclerosis Spina bifida
What is the symptoms of irritable Bowel Syndrome
abdominal pain
altered bowel habit
abdominal bloating
Belching wind and flatus
Mucus
What is the diagnostic criteria for IBD
Recurrent abdominal pain/discomfort for over 3 days a months in the past 3 months
associated with two or more symptoms
- improvement with defecation
- onset associated with change in stool frequent
- onset associated with change in stool form
What is the 4 variabilites of the abdominal pain in IBS
Vague
Bloating
Burning
Sharp
What is the cause of the abdominal pain in IBS
Bowel distension caused by altered bowel action
Does symptoms of IBS occur at night
No, rarely occurs
What is the different patterns of altered bowel habit in IBS
Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability
Urgency
What is the presentation of bloating in IBS
Very prominent, due to relaxation of abdominal wall muscle
accompanied by
- Wind and flatulence
- Mucus in stools
- Upper GI symptoms
What is the physical examinations that take place for diagnosing functional bowel diseases
Look for systemic disease
Abdominal examination
rectal examination
fecal occult blood test
What are the investigations carried out for the diagnosis of Irritable bowel syndrome
Blood analysis: FBC U & E, LFTs, Ca CRP (inflammatory marker) Thyroid function Coeliac serology
Stool culture
Calprotectin
Rectal examintaion + FOB
Colonoscopy - investigate concerning features
Why do we test for calprotectin
Is released by inflamed gut (IBD) mucosa into your stool
Differentiated IBS from IBD
-monitors IBD
What is the treatment plan for IBS
Diet review
Drug therapy
Target: pain, bloating, constipation, diarrhoea
Psychological intervention
What is recommended diet with IBS
FODMAP diet (fermentable oglio, Di and Mono-saccharides and plyols)
avoid:
tea/coffee/alcohol/sweetener
Exclude:
Lactose, gluten
What is examples of drug used to treat pain in IBS
Antispasmodics Linaclotide Antidepressants TCA, SSRIs
What are examples of drugs used to treat bloating
Probiotics
Linaclotide
(avoid bulking)
What is examples of drugs used to treat constipation
Laxatives
- bulking agents
- softeners
- stimulants
- osmotics
Linaclotide
What treatments should be avoided in constipation
TCA
FODMAP
What drugs are used to treat diarrhoea in IBS
Anti motility agents
FODMAP
What are you recommended to avoid with the symptoms of diarrhoea
SSRIs
What is examples of psychological intervention
Relaxation training
Hypnotherapy (relaxation)
Cognitive behavioural therapy (identify symptoms and respond)
Psychodynamic interpersonal therapy (how emotions and bowels interrelate)
What us the affect on the muscular tube in IBS-D patients
Muscular contractions may be stronger and more frequent than normal
What is the affect of the IBS-C on the muscular tube
Contraction may be reduced
Contractions can be triggered by waking and eating
what affect does IBS have on these triggers
In IBS-D, the response to these normal triggers may be stronger than normal.
In IBS-C, the response may be reduced
What affect does IBS have on the brain
Increases the strength of gut messages
What affect does IBS patients have on normal digestive process
Have an excessive awareness of digestive process
What affect does the psychosocial influences have on the physiological influences of IBS
IBS, the gut is more sensitive to stress, and this response can become chronic
