Functional bowel disorders Flashcards
Define functional bowel disorders
- No detectable pathology
- Related to gut function
- “software faults”
- Good long term prognosis
Give some examples of functional bowel disorders
- Oesophageal spasm
- Non-ulcer dyspepsia (NUD)
- Biliary dyskinesia
- Irritable bowel syndrome
- Slow transit constipation
- Drug related effects
Understand the impact of functional bowel disorders and the role of psychological factors
- 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
What is non-ulcer dyspepsia?
- Dyspeptic type pain
- No ulcer on endoscopy (H. pylori status varies
What is non-ulcer dyspepsia caused by?
probably not a single disease
- Reflux
- Low grade duodenal ulceration
- Delayed gastric emptying
- Irritable bowel syndrome
How do you diagnose non-ulcer dyspepsia?
- Careful History and Examination
- Family History - Gastric Cancer rare in those under 45 years
- H. pylori status
- Alarm symptoms
How do you treat non-ulcer dyspepsia?
- If all negative: Treat symptomatically
- If H. pylori positive: Eradication therapy
- If Doubt: Endoscopy
What is nausea?
The sensation of feeling sick
What is retching?
- Dry heaves
- Antrum contracts, glottis closed
What is vomiting?
Contents expelled
What are the sympathetic and Vagal components of vomiting and nausea?
- Vomiting Centre (may not exist as entity)
- Chemoreceptor Trigger Zone (CTZ)
- Receptors for opiates
- Digoxin
- Chemotherapy
- Uraemia
What would the history of nausea and vomiting be?
Length of time after food
- Immediate
- Psychogenic
- 1 hour or more
- Pyloric obstruction
- Motility disorders
~ Diabetes
~ Post gastrectomy
- 12 hours
- Obstruction etcWhat are the functional causes of nausea and vomiting
- Drugs
- Pregnancy
- Migraine
- Cyclical Vomiting Syndrome
- Onset often in childhood
- Recurrent episodes 2-3 x year – 2-3 x month - Alcohol
What is psychogenic vomiting?
- 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
What are alarm symptoms?
- 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
What is the aetiology of constipation?
- Systemic: Diabetes mellitus, hypothyroidism, hypercalcaemia
- Neurogenic: Autonomic neuropathies, Parkinson’s disease, strokes, multiple sclerosis, spina bifida
- Organic: Strictures, tumours, diverticular disease, proctitis, anal fissure
- Functional: Megacolon, idiopathic constipation, depression, psychosis, institutionalised patients
What are the clinical features of irritable bowel syndrome (IBS)
- Abdominal pain
- Altered bowel habit
- Abdominal bloating
- Belching wind and flatus
- Mucous
Symptoms of IBS usually occur in chronic relapsing, remitting manner
Describe the abdominal pain of IBS
- Very variable
- Vague
- Bloating
- Burning
- Sharp - Occasionally radiates, often to lower back
- Pain can be replicated by balloon inflation suggesting it may be due to bowel distension
- Often altered by bowel action
- Rarely occurs at night
What are the investigations for IBS?
- Blood analysis
- FBC
- U & E, LFTs, Ca
- CRP
- TFTs
- Coeliac serology - Stool Culture
- Calprotectin
- Rectal Examination and FOB
- ?Colonoscopy
What is calprotectin?
- Calprotectin released by inflamed gut mucosa
- Used for differentiating IBS from IBD and for monitoring IBD
What is the treatment of IBS?
- A firm diagnosis
- Education and reassurance
- Dietetic review
- Tea, coffee, alcohol, sweetener
- Lactose, gluten exclusion trial
- FODMAP
What is FODMAP?
- Fermentable Oligo-, Di- and Mono-Saccharides and Polyols
- Fructose
- Lactose
- fructins
- galactans
- Polyols
What drugs can you take to help with the pain of IBS?
- Antispasmodics
- Linaclotide (IBS-C)
- Antidepressants
- TCAs (IBS-D)
- SSRIs (IBS-C)
What drugs can you take to help with the bloating of IBS? (what should you avoid?)
- Some probiotics
- Linaclotide (IBS-C)
- Avoid: Bulking agents/ fibre
What drugs can you take to help with constipation in IBS? (what should you avoid?)
- Laxatives
- Bulking agents/ fibre (episodic)
- softeners (adjuvant)
- Stimulants (occasional)
- Osmotics (regular) - Linaclotide
- Avoid: TCAs, FODMAP
What drugs can you take to help with diarrhoea? (what should you avoid?)
- Anti motility agents
- FODMAP
- Avoid: SSRIs
What are the psychological interventions for IBS? What are they particularly effective for?
- Relaxation training: Diarrhoea, psychological co-morbidity
- Hypnotherapy: pain, constipation, flatulence, anxiety
- CBT: Abdominal pain, bloating, flatulence
- Psycho dynamic interpersonal therapy: a history of abuse
What causes IBS?
- Altered Motility
- Visceral Hypersensitivity
- Stress, Anxiety, Depression
What is the difference between IBS-C and D?
- In IBS-D, muscular contractions may be stronger and more frequent than normal. In IBS-C, contractions may be reduced
- In IBS-D, the response to these normal triggers may be stronger than normal. In IBS-C, the response may be reduced
