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GI: Pathology > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What is the difference between structural and functional disease?

A

Functional has no detectable pathology and structural does

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2
Q

Name some common functional GI disorders (6)

A 
Oesophageal spasm
Non-Ulcer Dyspepsia (NUD)
Biliary Dyskinesia
Irritable Bowel syndrome
Slow Transit Constipation
Drug Related Effects
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3
Q

Describe the main features of non-ulcer dyspepsia (3)

A

Dyspeptic like pain
No ulcer on endoscopy
May involve reflux, low grade duodenal ulceration, delayed gastric emptying and IBS

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4
Q

What is vomiting, nausea and retching?

A

Nausea: the sensation of feeling sick
Retching: dry heaves -
antrum contracts, glottis closed
Vomiting: contents expelled

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5
Q

What are some functional causes of vomiting?

A 
Drugs
Pregnancy
Migraine
Cyclical Vomiting Syndrome
Alcohol
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6
Q

How is vomiting controlled neurologically?

A

Both sympathetic and vagal components
Vomiting centre of brain
Chemo-receptor trigger zone

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7
Q

What may be indicated if there is vomiting immediately after eating?

A

Psychogenic vomiting (vomiting without any obvious pathology)

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8
Q

What pathologically may be indicated if there is vomiting 1 hour after eating?

A

Pyloric obstruction
Motility disorders
(Diabetes,
Post gastrectomy)

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9
Q

What pathologically may be indicated if there is vomiting 12 hours after eating?

A

Obstruction

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10
Q

What are some of the main features of psychogenic vomiting? (gender, time period, triggers, appetite and management)

A

Often young women
Often for years
May be self induced with no nausea preceding
Appetite not disturbed but may lose weight
May stop after admission

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11
Q

Describe the Bristol Stool Chart (7)

A

1: Separate hard lumps like nuts
2: Lumpy and sausage shaped
3: Like a sausage but with cracks
4: Like a smooth sausage
5: Soft blobs with clear cut edges
6: Fluffy pieces with a ragged edges, mushy
7: Watery, no solid pieces

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12
Q

What is a T2 stool like?

A

Sausage shaped but lumpy

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13
Q

What is a T3 stool like?

A

Cracked, sausage shaped

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14
Q

What is a T5 stool like?

A

Soft blobs with clear cut edges

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15
Q

What is a T6 stool like?

A

Fluffy pieces with a ragged edges, mushy

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16
Q

What are alarm symptoms in a patient with GI complaints? (10)

A 
Age 50+
Short symptom history
Unintentional weight loss
Nocturnal symptoms
Male 
Family history of bowel/ovarian cancer 
Anaemia 
Rectal bleeding
Recent antibiotic use
Abdominal mass
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17
Q

What are the four categories of constipation aetiology? (4)

A

Systemic
Neurogenic
Organic
Functional

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18
Q

What are some examples of organic causes of constipation? (5)

A 
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure
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19
Q

What are some examples of functional causes of constipation? (5)

A 
Mega colon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
20
Q

What are some examples of systemic causes of constipation? (3)

A

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

21
Q

What are some neurogenic causes of constipation? (5)

A 
Autonomic neuropathies
Parkinson's disease
Strokes
Multiple sclerosis
Spina bifida
22
Q

What are the clinical features of IBS? (5)

A 
Abdominal pain
Altered bowel habit
Abdominal bloating
Belching wind and flatus
Mucus after defecation
23
Q

How do the symptoms of IBS usually occur?

A

In a chronic, relapsing-remitting manner

24
Q

What is the ROME III Diagnostic criteria for IBS?

A

Recurrent abdominal pain/discomfort for more than 3 days per month + 2 or more of:

  • Improvement with defecation
  • Onset associated with change in stool frequency
  • Onset associated with change in stool form
25
Q

What is the NICE criteria for IBS?

A

Abdominal pain/discomfort relieved by defecation or associated with altered stool frequency/form + 2 or more of:

  • Altered stool passage
  • Abdominal bloating/distension
  • Symptoms worse by eating
  • Passage of mucus
26
Q

Where may abdominal pain radiate?

A

Back

27
Q

Why do we think abdominal pain may be associated with bowel distension?

A

It can be replicated by balloon inflation

28
Q

What is IBS-C?

A

Constipation predominant IBS

29
Q

What is IBS-D?

A

Diarrhoea predominant IBS

30
Q

What is IBS-M?

A

Both constipation and diarrhoea in IBS

31
Q

What can cause abdominal bloating? (2)

A

Relaxation of abdominal muscles

Wind and flatulence

32
Q

What are the two key components of an IBS diagnosis? (2)

A

A compatible history

Normal physical examination

33
Q

What are some of the investigations you may do in IBS to rule out other conditions? (5)

A

Stool culture
Calprotectin
Rectal examination
Faecal occult blood test

Blood analysis -
Coeliac serology
TFTs
CRP
U+E, LFTs, Ca
FBC
34
Q

What is released by inflamed gut mucosa?

A

Calprotectin

35
Q

What is the general treatment for IBS? (3)

A

A firm diagnosis
Education and reassurance
Dietetic review

36
Q

What may be involved in a dietetic review in IBS? (3)

A

Look at tea, coffee, alcohol and sweetener use
Lactose and gluten exclusion trial
FODMAP

37
Q

What does FODMAP stand for?

A

Fermentable oligo-. di-. and monosaccharides and polyols

38
Q

What pharmacological treatments may be given for pain in IBS? (2)

A

Antispasmodics

Linaclotide (IBS-C)

39
Q

What pharmacological treatments may be given for bloating in IBS? (2)

A

Some probiotics

Linaclotide (IBS-C)

40
Q

What can be given for constipation in IBS? (2)

A

Linaclotide

Laxatives (bulking agents, softeners as adjuvant, occasional stimulants and regular osmotics)

41
Q

What should be avoided in IBS-C? (2)

A

TCAs

FODMAP

42
Q

What can be given for diarrhoea in IBS?

A

Anti-motility agents

FODMAP

43
Q

What should be avoided in diarrhoea in IBS?

A

SSRIs

44
Q

What are some psychological interventions that may be useful in IBS? (4)

A

Relaxation therapy
Hypnotherapy
CBT
Psychodynamic interpersonal therapy

45
Q

What causes IBS? (3)

A

Altered motility
Visceral hypersensitivity
Stress, anxiety and depression

46
Q

What effect do opiates have on bowel habit?

A

Constipation

GI: Pathology (24 decks)

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