Functional Bowel Disorders Flashcards
What is the difference between structural and functional disease?
Functional has no detectable pathology and structural does
Name some common functional GI disorders (6)
Oesophageal spasm Non-Ulcer Dyspepsia (NUD) Biliary Dyskinesia Irritable Bowel syndrome Slow Transit Constipation Drug Related Effects
Describe the main features of non-ulcer dyspepsia (3)
Dyspeptic like pain
No ulcer on endoscopy
May involve reflux, low grade duodenal ulceration, delayed gastric emptying and IBS
What is vomiting, nausea and retching?
Nausea: the sensation of feeling sick
Retching: dry heaves -
antrum contracts, glottis closed
Vomiting: contents expelled
What are some functional causes of vomiting?
Drugs Pregnancy Migraine Cyclical Vomiting Syndrome Alcohol
How is vomiting controlled neurologically?
Both sympathetic and vagal components
Vomiting centre of brain
Chemo-receptor trigger zone
What may be indicated if there is vomiting immediately after eating?
Psychogenic vomiting (vomiting without any obvious pathology)
What pathologically may be indicated if there is vomiting 1 hour after eating?
Pyloric obstruction
Motility disorders
(Diabetes,
Post gastrectomy)
What pathologically may be indicated if there is vomiting 12 hours after eating?
Obstruction
What are some of the main features of psychogenic vomiting? (gender, time period, triggers, appetite and management)
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
Describe the Bristol Stool Chart (7)
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
What is a T2 stool like?
Sausage shaped but lumpy
What is a T3 stool like?
Cracked, sausage shaped
What is a T5 stool like?
Soft blobs with clear cut edges
What is a T6 stool like?
Fluffy pieces with a ragged edges, mushy
What are alarm symptoms in a patient with GI complaints? (10)
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
What are the four categories of constipation aetiology? (4)
Systemic
Neurogenic
Organic
Functional
What are some examples of organic causes of constipation? (5)
Strictures Tumours Diverticular disease Proctitis Anal fissure
What are some examples of functional causes of constipation? (5)
Mega colon Idiopathic constipation Depression Psychosis Institutionalised patients
What are some examples of systemic causes of constipation? (3)
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are some neurogenic causes of constipation? (5)
Autonomic neuropathies Parkinson's disease Strokes Multiple sclerosis Spina bifida
What are the clinical features of IBS? (5)
Abdominal pain Altered bowel habit Abdominal bloating Belching wind and flatus Mucus after defecation
How do the symptoms of IBS usually occur?
In a chronic, relapsing-remitting manner
What is the ROME III Diagnostic criteria for IBS?
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
What is the NICE criteria for IBS?
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
Where may abdominal pain radiate?
Back
Why do we think abdominal pain may be associated with bowel distension?
It can be replicated by balloon inflation
What is IBS-C?
Constipation predominant IBS
What is IBS-D?
Diarrhoea predominant IBS
What is IBS-M?
Both constipation and diarrhoea in IBS
What can cause abdominal bloating? (2)
Relaxation of abdominal muscles
Wind and flatulence
What are the two key components of an IBS diagnosis? (2)
A compatible history
Normal physical examination
What are some of the investigations you may do in IBS to rule out other conditions? (5)
Stool culture
Calprotectin
Rectal examination
Faecal occult blood test
Blood analysis - Coeliac serology TFTs CRP U+E, LFTs, Ca FBC
What is released by inflamed gut mucosa?
Calprotectin
What is the general treatment for IBS? (3)
A firm diagnosis
Education and reassurance
Dietetic review
What may be involved in a dietetic review in IBS? (3)
Look at tea, coffee, alcohol and sweetener use
Lactose and gluten exclusion trial
FODMAP
What does FODMAP stand for?
Fermentable oligo-. di-. and monosaccharides and polyols
What pharmacological treatments may be given for pain in IBS? (2)
Antispasmodics
Linaclotide (IBS-C)
What pharmacological treatments may be given for bloating in IBS? (2)
Some probiotics
Linaclotide (IBS-C)
What can be given for constipation in IBS? (2)
Linaclotide
Laxatives (bulking agents, softeners as adjuvant, occasional stimulants and regular osmotics)
What should be avoided in IBS-C? (2)
TCAs
FODMAP
What can be given for diarrhoea in IBS?
Anti-motility agents
FODMAP
What should be avoided in diarrhoea in IBS?
SSRIs
What are some psychological interventions that may be useful in IBS? (4)
Relaxation therapy
Hypnotherapy
CBT
Psychodynamic interpersonal therapy
What causes IBS? (3)
Altered motility
Visceral hypersensitivity
Stress, anxiety and depression
What effect do opiates have on bowel habit?
Constipation
