Functional Bowel Disorders Flashcards
What are the 2 broad categories of GI disease?
Structural
Functional
What are the alarm symptoms of the GI tract?
Age >50 Short symptom history Unintentional weight loss Night symptoms Male FH of cancer Anaemia Rectal bleeding Recent AB use Abdominal mass
Will functional bowel disorders cause nocturnal symptoms?
No
What can AB use cause?
Change in bowels
What should you consider for bowel habits when taking a patient history?
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
What GI investigations should be done for alarm symptom patients?
o FBC o Blood glucose o U+E o Thyroid o Coeliac serology o Proctoscopy o Sigmoidoscopy o Colonoscopy
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?
Colonoscopy
What are organic causes of constipation?
Strictures Tumours Diverticular disease Proctitis Anal fissure
What are systemic causes of constipation?
DM
Hypothyroidism
Hypercalcaemia
What are neurogenic causes of constipation?
Autonomic neuropathies Parkinson’s Strokes MS Spina Bifida
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?
IBS
What are clinical features of IBS?
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
Is bloating common in IBS?
Yes
What are the investigations for bloating?
o Blood analysis
- FBC
- U&E’s
- LFTs
- Ca – no malabsorption
- CRP – any inflammatory
- TFTs – any thyroid issues?
- Coeliac Serology – gluten free?
What are the investigations for persisting bloating?
Stool culture
Calcprotectin
Rectal examination
Colonoscopy
does IBS have any inflammation in the gut?
No
Does IBD have any inflammation in the gut?
Yes
What is calcprotectin?
Protein released by the inflamed gut
What is the treatment for IBS?
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
Is IBS easy to treat?
No notoriously difficult
What are the triggers of IBS?
tress
Anxiety
Depression
In IBS what does the gut hear too loudly?
The brain
Do people with IBS have an increased or decreased awareness of their digestive system?
Increased
How is IBS diagnosed:
Recurrent abdominal pain associated with 2 of: Relief by defecation Altered stool form Altered bowel frequency Urgency Incomplete evacuation Bloating/Distension
How is constipation managed in IBS?
Adequate fluid and fibre intake, increased exercise, laxatives
How is diarrhoea managed in IBS?
Avoid foods such as: Sweeteners Alcohol Caffeine Reduce fibre intake Avoid food that upset bowels
How is bloating managed in IBS?
Anti-spasmodics
Pro-biotics
Diet low in fermentable fibre
When should patients with IBS sounding symptoms be sent for colonoscopy?
If any alarm features e.g weight loss, rectal bleeding are present
Or if strong FH have a lower threshold for referral
