Functional bowel disorders Flashcards
1
Q
Define functional bowel disorders
A
- No detectable pathology
- Related to gut function
- “software faults”
- Good long term prognosis
2
Q
Give some examples of functional bowel disorders
A
- Oesophageal spasm
- Non-ulcer dyspepsia (NUD)
- Biliary dyskinesia
- Irritable bowel syndrome
- Slow transit constipation
- Drug related effects
3
Q
Understand the impact of functional bowel disorders and the role of psychological factors
A
- Very common cause of initial and return medical consultations
- Large impact on quality of life
- Large cause of work absences
- Psychological factors are important
- Not associated with the development of a serious pathology
4
Q
What is non-ulcer dyspepsia?
A
- Dyspeptic type pain
- No ulcer on endoscopy (H. pylori status varies
5
Q
What is non-ulcer dyspepsia caused by?
A
probably not a single disease
- Reflux
- Low grade duodenal ulceration
- Delayed gastric emptying
- Irritable bowel syndrome
6
Q
How do you diagnose non-ulcer dyspepsia?
A
- Careful History and Examination
- Family History - Gastric Cancer rare in those under 45 years
- H. pylori status
- Alarm symptoms
7
Q
How do you treat non-ulcer dyspepsia?
A
- If all negative: Treat symptomatically
- If H. pylori positive: Eradication therapy
- If Doubt: Endoscopy
8
Q
What is nausea?
A
The sensation of feeling sick
9
Q
What is retching?
A
- Dry heaves
- Antrum contracts, glottis closed
10
Q
What is vomiting?
A
Contents expelled
11
Q
What are the sympathetic and Vagal components of vomiting and nausea?
A
- Vomiting Centre (may not exist as entity)
- Chemoreceptor Trigger Zone (CTZ)
- Receptors for opiates
- Digoxin
- Chemotherapy
- Uraemia
12
Q
What would the history of nausea and vomiting be?
A
Length of time after food
- Immediate
- Psychogenic
- 1 hour or more
- Pyloric obstruction
- Motility disorders
~ Diabetes
~ Post gastrectomy
- 12 hours
- Obstruction etc
13
Q
What are the functional causes of nausea and vomiting
A
- Drugs
- Pregnancy
- Migraine
- Cyclical Vomiting Syndrome
- Onset often in childhood
- Recurrent episodes 2-3 x year – 2-3 x month - Alcohol
14
Q
What is psychogenic vomiting?
A
- Often young women
- Often for years
- May have no preceding nausea
- May be self induced (overlap with bulimia)
- Appetite usually not disturbed but may lose weight
- Often stops shortly after admission
15
Q
What are alarm symptoms?
A
- Age > 50
- Short symptom history
- Unintentional weight loss
- Nocturnal symptoms
- Male sex
- Family history of bowel/ ovarian cancer
- Anaemia
- Rectal bleeding
- Recent antibiotic use
- Abdominal mass
