Functional bowel disorders Flashcards
what are the two broad categories of GI disease
structural and functional
what classifies functional GI disease
No detectable pathology
Related to gut function
Can be found all the way through the gut
“Software faults”
Long-term prognosis good
list some functional GI disorders
Oesophageal spasm
Non-Ulcer Dyspepsia (NUD)
Biliary Dyskinesia
Irritable Bowel syndrome
Slow Transit Constipation
Drug Related Effects
what are some key points to consider for functional disorders
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
what is non-ulcer dyspepsia
dyspeptic type pain with no ulcer on endoscopy
affects upper GI
no structural abnormality
(H pylori status varies)
what other diseases is non-ulcer dyspepsia associated with
Reflux
Low grade duodenal ulceration
Delayed Gastric emptying
Irritable bowel syndrome
how can non-ulcer dyspepsia be diagnosed
careful history and examination
- family history
H pylori status
alarm symptoms
exclude gastric cancer
how should non-ulcerdyspepia be treated
treat symptomatically
- 6 day course PPI ameprazole
if h pylori positive - eradication therapy
if doubt - endoscope
what is nausea
the sensation of feeling sick
what is retching
dry heaves
antrum contracts but glottis is closed
what os vomiting
contents being expelled from the stomach
what components cause nausea and vomiting
sympathetic and vagal components
chemoreceptor trigger zone (CTZ)
- receptors for opiates
- digoxin
- chemotherapy
- uraemia
- renal failure
what questions should asked in a history for vomiting and what might they indicate
Length of time after food:
Immediate (?Psychogenic)
1 hour or more
- Pyloric obstruction
- Motility disorders (Diabetes,
Post gastrectomy)
12 hours
- Obstruction etc
what are functional causes of vomiting
Drugs
Pregnancy
Migraine
Cyclical Vomiting Syndrome
- Onset often in childhood
- Recurrent episodes 2-3 x year – 2-3 x month
Alcohol
what occurs in 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 the two functional diseases of the lower GI tract
irritable bowel syndrome
slow transit constipation
what are key questions to ask a patient during a history
“What is normal for you?”
Change in frequency
Duration - recent onset? from birth?
Soiling?
Consistency
Blood
Mucus
Drugs?
what should be looked for in the physical examination
systemic disease
careful abdominal examination
rectal examination
what are alarm symptoms
- 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
what investigations should be done
FBC Blood glucose U + E, etc. Thyroid status Coeliac serology Proctoscopy Sigmoidoscopy colonoscopy
what are the different groups of causes of constipation
systemic
neurogenic
organic
functional
what are organic causes of constipation
Strictures Tumours Diverticular disease Proctitis Anal fissure
what are functional causes of constipation
Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients
what are systemic causes of constipation
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
