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GI > Functional bowel disorders > Flashcards

Functional bowel disorders Flashcards

1
Q

what are the two broad categories of GI disease

A

structural and functional

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2
Q

what classifies functional GI disease

A

No detectable pathology

Related to gut function

Can be found all the way through the gut

“Software faults”

Long-term prognosis good

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3
Q

list some functional GI disorders

A

Oesophageal spasm

Non-Ulcer Dyspepsia (NUD)

Biliary Dyskinesia

Irritable Bowel syndrome

Slow Transit Constipation

Drug Related Effects

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4
Q

what are some key points to consider for functional disorders

A

Very common cause of initial and return medical consultations

Large impact on quality of life

Large cause of work absences

Vast majority can be diagnosed with history and examination

Psychological factors important

Not associated with development of serious pathology

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5
Q

what is non-ulcer dyspepsia

A

dyspeptic type pain with no ulcer on endoscopy

affects upper GI

no structural abnormality

(H pylori status varies)

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6
Q

what other diseases is non-ulcer dyspepsia associated with

A

Reflux

Low grade duodenal ulceration

Delayed Gastric emptying

Irritable bowel syndrome

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7
Q

how can non-ulcer dyspepsia be diagnosed

A

careful history and examination
- family history

H pylori status

alarm symptoms

exclude gastric cancer

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8
Q

how should non-ulcerdyspepia be treated

A

treat symptomatically
- 6 day course PPI ameprazole

if h pylori positive - eradication therapy

if doubt - endoscope

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9
Q

what is nausea

A

the sensation of feeling sick

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10
Q

what is retching

A

dry heaves

antrum contracts but glottis is closed

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11
Q

what os vomiting

A

contents being expelled from the stomach

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12
Q

what components cause nausea and vomiting

A

sympathetic and vagal components

chemoreceptor trigger zone (CTZ)

  • receptors for opiates
  • digoxin
  • chemotherapy
  • uraemia
  • renal failure
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13
Q

what questions should asked in a history for vomiting and what might they indicate

A

Length of time after food:

Immediate (?Psychogenic)

1 hour or more
- Pyloric obstruction
- Motility disorders (Diabetes,
Post gastrectomy)

12 hours
- Obstruction etc

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14
Q

what are functional causes of vomiting

A

Drugs

Pregnancy

Migraine

Cyclical Vomiting Syndrome

  • Onset often in childhood
  • Recurrent episodes 2-3 x year – 2-3 x month

Alcohol

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15
Q

what occurs in 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

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16
Q

what are the two functional diseases of the lower GI tract

A

irritable bowel syndrome

slow transit constipation

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17
Q

what are key questions to ask a patient during a history

A

“What is normal for you?”

Change in frequency

Duration - recent onset? from birth?

Soiling?

Consistency

Blood

Mucus

Drugs?

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18
Q

what should be looked for in the physical examination

A

systemic disease

careful abdominal examination

rectal examination

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19
Q

what are alarm symptoms

A
  • age>50
  • short symptoms history (weeks rather than years)
  • unintentional weight loss
  • noctural symptoms
  • male
  • family history of bowel/ovarian cancer
  • anaemia
  • rectal bleeding
  • recent antibiotic use
  • abdominal mass
20
Q

what investigations should be done

A 
FBC
Blood glucose
U + E, etc.
Thyroid status
Coeliac serology
Proctoscopy
Sigmoidoscopy
colonoscopy
21
Q

what are the different groups of causes of constipation

A

systemic
neurogenic
organic
functional

22
Q

what are organic causes of constipation

A 
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure
23
Q

what are functional causes of constipation

A 
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
24
Q

what are systemic causes of constipation

A

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

25
Q

what are neurogenic causes of constipation

A 
Autonomic neuropathies
Parkinson's disease
Strokes
Multiple sclerosis
Spina bifida
26
Q

what is irritable bowel syndrome

A

IBS is a group of symptoms (including abdominal pain, irregular bowel habits) without evidence of underlying damage

27
Q

what are the clinical features of IBS

A 
abdominal pain (improved by defaecation) 
altered bowel habit
altered stool form 
abdominal bloating 
belching, wind, flatus
mucus in stool

can occur over a number of years

28
Q

how do the symptoms of IBS usually occur

A

occur in a chronic relapsing, remitting manner

29
Q

what are the features of abdominal pain that may be felt in IBS

A 
very variable:
Vague
Bloating
Burning
Sharp

Occasionally radiates, often to lower back

rarely occurs at night

often altered by bowel action

pain can be replicated by ballot inflation suggesting it may be due to bowel distention

30
Q

what are the different types of altered bowel habits in IBS

A
  • constipation (IBS-C)
  • diarrhoea (IBS-D)
  • both diarrhoea and constipation (IBS-M)
  • variability
  • urgency
31
Q

what symptoms often accompany bloating in IBS

A
  • Wind and flatulence
  • Relaxation abdominal wall muscles
  • Mucus in stool
  • Upper and other gastrointestinal symptoms
  • Heartburn
  • Lower satiety
32
Q

what investigations can be done to test for IBS

A

Blood analysis

  • FBC
  • U & E, LFTs, Ca
  • CRP
  • TFTs
  • Coeliac serology

Stool Culture
Calprotectin
Rectal Examination and FOB
?Colonoscopy

33
Q

what is calprotectin

A

complex released in response to inflammation

34
Q

what can calprotectin levels be used for

A

to differentiate IBS from IBD and for monitoring IBD

levels lower in IBS

35
Q

what is the treatment for IBS

A

A firm diagnosis

Education and reassurance

Dietetic review

  • Tea, coffee, alcohol, sweetener
  • Lactose, gluten exclusion trial
  • FODMAP (diet)
36
Q

what drugs can be used for pain management

A

antispasmodics

linaclotide (IBS-C)

37
Q

what drugs can be used for bloating

A

some probiotics
linaclotide (IBS-C)

avoid bulking agents and fibre

38
Q

what drugs can be used for constipation

A

laxatives
linaclotide

avoid FODMAP

39
Q

what drugs can be used for diarrhoea

A

antimotility agents

FODMAP

40
Q

what type of psychological interventions can be used

A

relaxation training
hypnotherapy
cognitive behavioural therapy
psychodynamic interpersonal therapy

41
Q

what can cause IBS

A

altered motility
visceral hypersensitivity
stress, anxiety, depression

42
Q

how do bowel contractions differ in IBS-D and IBS-C

A

IBS-D = stinger and more frequent

IBS-C = reduced

43
Q

how might gut response to triggers be altered in IBS

A

contractions could be triggered by waking and eating

IBS-D = triggers stronger than normal

IBS-C = response reduced

44
Q

how might the brain “hear the gut too loudly” in IBS

A

messages from the gut to the brain such as hunger or the need to go to the toilet may be larger than normal

45
Q

how might heightened awareness affect IBS

A

The gut works all day, every day, but most people do not feel it

People with IBS often have an excessive awareness of normal digestive processes

46
Q

how is the stress response affected in IBS

A

may be chronic - the gut is more sensitive to stress

GI (25 decks)

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