Functional Bowel Disorders Flashcards
Define functional bowel disorders
Persistent and recurring GI symptoms, that occur due to abnormal functioning of the GI tract
What are the two different types of FBD and what is the difference?
- Structural: detectable pathology - macroscopic (i.e. cancer) or microscopic (i.e. colitis)
- Functional: no detectable pathology
Name six different FBD
- Oesophageal spasm
- Non-ulcer dyspepsia
- Biliary dyskinesia
- Irritable bowel syndrome
- Slow transit constipation
- Drug related effects
How can FBD impact psychologically?
QOL and cause of work absences
What is the causative organisms of non-ulcerative dyspepsia?
H. pylori
How is Non-ulcerative dyspepsia diagnosed?
- History (delayed gastric emptying, IBS) and examination
* H. pylori status and alarm symptoms
What is the treatment of non-ulcerative dyspepsia?
Depends on H. pylori status:
• Negative -> treat symptomatically
• Positive -> eradication therapy
• In doubt -> endoscopy
Describe the sympathetic and vagal components of vomiting and nausea
- Vomiting centre - induce vomiting when stimulated
- Chemoreceptor trigger zone - area of medulla that sense chemical abnormalities in the body (digoxin, chemotherapy, opiates, uraemia) and send excitatory signals to the vomiting centres
Name five functional causes of vomiting
- Drugs
- Pregnancy
- Migraine
- Cyclical vomiting syndrome
- Alcohol
What can the length of time after eating tell you about the cause of vomiting?
- Immediate -> psychogenic
- 1 hour or more -> pyloric obstruction or motility disorders (i.e. diabetes, post gastrectomy)
- After 12 hours -> obstruction
What is psychogenic vomiting?
- Often young women and for Yeats
- No preceding nausea
- May be self-induced (overlap with bulimia)
- Appetite not usually disturbed but may los weight
Name the alarm symptoms for FBD
- Over 50yrs
- Unintentional weight loss
- Nocturnal symptoms
- Male
- Family history
- Anaemia
- Rectal bleeding
- Recent antibiotic use
- Abdominal mass
Name the investigations used for FBD
- FBC
- Blood gucose
- U+Es
- Thyroid status
- Coeliac serology
- FIT testing
- Calprotectin stool test
- Sigmoidoscopy
- Colonoscopy
What can thyroid status indicate about FBD?
- Hyperthyroidism -> diarrhoea
* Hypothyroidism -> constipation
What does calprotectin stool test indicate?
Calprotectin is a protein found on WBC, and is activated when inflammation occurs, so can identify inflammatory bowel conditions
What are four classifications of causes of constipation?
- Organic
- Functional
- Systemic
- Neurogenic
Name five organic causes of constipation
- Strictures
- Tumours
- Diverticular disease
- Proctitis
- Anal fissure
Name five functional causes of constipation
- Megacolon
- Idiopathic constipation
- Depression
- Psychosis
- Institutionalised patients
Name three systemic causes of constipation
- Diabetes mellitus
- Hypothyroidism
- Hypercalcaemia
Name five neurogenic causes of constipation
- Autonomic neuropathies
- Parkinson’s disease
- Stroke
- Multiple sclerosis
- Spina bifida
What is the presentation of irritable bowel syndrome?
- Abdominal pain
- Altered bowel habit
- Abdominal bloating
- Belching wind ans flatus
- Mucus
Describe the features of abdominal pain in IBS
- Variable: vague, bloating, burning, sharp
- Can radiate to lower park
- Altered by bowel action
What test can differentiate IBS and IBD?
Calprotectin stool test - released by inflamed gut mucosa
What investigations do you use for IBS?
- Bloods: FBC, U+Es, LFTS, Ca, CRP, TFTs, Coeliac serology
- Stool culture
- Calprotectin stool test
- FIT testing
What are the management options of IBS?
- Dietetic review
- Drug therapy
- Psychological interventions
What is involved in the dietetic review of IBS?
- Lactose, gluten exclusion trial
* FODMAP diet
What is involved in the drug therapy of IBS?
- Pain: antispasmodics, linaclotide
- Bloating: probiotics, linaclotide (IBS-C)
- Consipation: laxatives, linaclotide
- Diarrhoea: anti motility agents, FODMAP
What are different strategies in psychological interventions for IBS?
- Relaxation training
- Hypnotherapy
- Cognitive behavioural therapy
- Psychogenic interpersonal therapy
What are three different causes of IBS?
- Altered motility
- Visceral hypersensitivity
- Stress, anxiety, depression
What is IBS-C?
Constipation
What is IBS-D?
Diarrhoea
What happens to muscular contractions and gut response to triggers in IBS-C and IBS-D?
- IBS-C - reduced
* IBS-D - stronger or more frequent
