Define: 1. Nausea 2. Retching 3. Vomiting

1. Sensation of feeling sick 2. Dry heaves 3. Contents expelled

Functional Bowel Disorders Flashcards by Sarah Anderson

What is the two categories of GI diseases

Structutal

Functional

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What is the features of structural GI diseases

Detectable Pathology

Usual affects function

Prognosis depends on pathology

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What is the features of functional GI diseases

No detectable pathology

Related to gut function
Long-term prognosis good

psychological factors important

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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

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Define Biliary Dyskinesia

Bile cannot properly move in the proper direction through tubular glands

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What other diseases is non ulcer dyspepsia accosiated with

Reflux

Low grade duodenal ulceration

Delayed gastric emptying

Irritable bowel syndrome

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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)

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How is Non ulcer dyspepsia investigated

Endoscopy

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How do you treat non ulcer dyspepsia

H.pylori negative and no alarm symptoms- treat acid suppression e.g. omeprazole

H.Pylor postive - Eradication

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Define:

Nausea
Retching
Vomiting

Sensation of feeling sick
Dry heaves
Contents expelled

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What is the mechanism of retching

Antrum contracts while glottis is closed so nothing is expelled

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Vommiting has both sympathetic and vagal components what receptors do these act upon

Vomiting centre

Chemoreceptor trigger zone
   Receptors for opiates
   Digoxin
   Chemotherapy
   Uraemia

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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

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What is functional causes of vomiting

Drugs

Pregnancy

Migraine
- causes abdominal pain

Cyclical Vomiting Syndrome (recurrent attacks)

Alcohol

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What is the features of psychogenic vomiting

Happens with no preceding nausea

potentially self induced
appetite usually not disturbed
may lose weight

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What are the two specific functional disease of the Lower GI tract

Irritable bowel syndrome

slow transit constipation

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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

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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

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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

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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