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Alimentary System > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What are the 2 broad categories of GI disease?

A

Structural

Functional

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2
Q

What are the alarm symptoms of the GI tract?

A 
Age >50 
Short symptom history 
Unintentional weight loss 
Night symptoms 
Male 
FH of cancer 
Anaemia 
Rectal bleeding 
Recent AB use 
Abdominal mass
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3
Q

Will functional bowel disorders cause nocturnal symptoms?

A

No

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4
Q

What can AB use cause?

A

Change in bowels

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5
Q

What should you consider for bowel habits when taking a patient history?

A 
What is normal for the patient?
Changes in bowel frequency 
Changes in consistency 
Is there any blood present 
Is there any mucous present 
Faceal incontinence
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6
Q

What GI investigations should be done for alarm symptom patients?

A 
o	FBC 
o	Blood glucose 
o	U+E
o	Thyroid 
o	Coeliac serology 
o	Proctoscopy 
o	Sigmoidoscopy 
o	Colonoscopy
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7
Q 
65 year old man	smoker 
FH
-	Father and brother cancer 
6 month history of increasing constipation 
Some dark red blood in the stool 
Now losing weight
What investigations would you carry out?
A

Colonoscopy

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8
Q

What are organic causes of constipation?

A 
Strictures
Tumours 
Diverticular disease
Proctitis 
Anal fissure
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9
Q

What are systemic causes of constipation?

A

DM
Hypothyroidism
Hypercalcaemia

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10
Q

What are neurogenic causes of constipation?

A 
Autonomic neuropathies
Parkinson’s
Strokes
MS
Spina Bifida
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11
Q

CASE HISTORY: Heather

o      29 year old 
o	Female 
o	No FH
o	2 year history of irregular bowel habit 
Loose stools 
o	Increased frequency 
o	Colicky pain relieved by defecation 
o	No passage of blood 
o	No weight loss 
Examination:
o	Normal physical examination 
o	Normal PR
o	FOB negative 
o	Blood tests normal 
o	Colonoscopy and biopsynormal

What is the diagnosis?

A

IBS

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12
Q

What are clinical features of IBS?

A 
o	Abdominal pain 
o	Altered bowel habit 
o	Abdominal bloating 
o	Belching wind and flatus 
o	Mucus (not particularly a concern)
o	Need to meet diagnostic criteria
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13
Q

Is bloating common in IBS?

A

Yes

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14
Q

What are the investigations for bloating?

A

o Blood analysis

  • FBC
  • U&E’s
  • LFTs
  • Ca – no malabsorption
  • CRP – any inflammatory
  • TFTs – any thyroid issues?
  • Coeliac Serology – gluten free?
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15
Q

What are the investigations for persisting bloating?

A

Stool culture
Calcprotectin
Rectal examination
Colonoscopy

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16
Q

does IBS have any inflammation in the gut?

A

No

17
Q

Does IBD have any inflammation in the gut?

A

Yes

18
Q

What is calcprotectin?

A

Protein released by the inflamed gut

19
Q

What is the treatment for IBS?

A 
o	A firm diagnosis 
o	Education and reassurance 
o	Dietetic review 
o	 Removal of Common diarrhoea foods 
-	Tea 
-	Coffee
-	Alcohol 
-	Sweetener
-	Lactose trial to test for lactose intolerance
-	Gluten exclusion trial
20
Q

Is IBS easy to treat?

A

No notoriously difficult

21
Q

What are the triggers of IBS?

A

tress
Anxiety
Depression

22
Q

In IBS what does the gut hear too loudly?

A

The brain

23
Q

Do people with IBS have an increased or decreased awareness of their digestive system?

A

Increased

24
Q

How is IBS diagnosed:

A 
Recurrent abdominal  pain associated with 2 of:
Relief by defecation 
Altered stool form 
Altered bowel frequency 
Urgency 
Incomplete evacuation 
Bloating/Distension
25
Q

How is constipation managed in IBS?

A

Adequate fluid and fibre intake, increased exercise, laxatives

26
Q

How is diarrhoea managed in IBS?

A 
Avoid foods such as:
Sweeteners
Alcohol 
Caffeine 
Reduce fibre intake 
Avoid food that upset bowels
27
Q

How is bloating managed in IBS?

A

Anti-spasmodics
Pro-biotics
Diet low in fermentable fibre

28
Q

When should patients with IBS sounding symptoms be sent for colonoscopy?

A

If any alarm features e.g weight loss, rectal bleeding are present
Or if strong FH have a lower threshold for referral

Alimentary System (29 decks)

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