Functional bowel disorders Flashcards
Define functional bowel disorders
Those with no detectable pathology, i.e. organ is fine histologically but there’s a problem with how the organ works
List some functional bowel disorders (4)
Irritable bowel syndrome
Oesophageal spasm
Non-ulcer dyspepsia
Biliary dyskinesia
What is non-ulcer dyspepsia (functional dyspepsia)/ symptoms
Dyspepsia symptoms without any duodenal/gastric ulcers or gastric cancers:
Epigastric pain
Nausea
Vomiting
How would you assess non-ulcer dyspepsia (2)
History + examination
-ask about vomiting esp
-ask about ALARM symptoms
Check for H.pylori infection
Vomiting immediately after eating suggests what diagnosis
Psychogenic vomiting
Vomiting an hour or more after eating suggests what diagnosis
pyloric obstruction or motility disorders
Vomiting 12 hours after eating suggests what diagnosis
Intestinal obstruction
Functional causes of vomiting (5)
Drugs Pregnancy Migraine Cyclical vomiting syndome Alcohol
4 aetiological types of constipation
Organic, e.g. strictures, tumours
Functional, e.g. distended colon
Systemic, e.g. diabetes
Neurogenic, e.g. parkinson’s
What is irritable bowel syndrome
Chronic condition characterised by abdominal pain associated with bowel dysfunction.
The pain is often relieved by defecation
Triggers of IBS
Stress
Anxiety
Depression
Aetiology of IBS (5)
Multifactorial
- VISCERAL HYPERSENSITIVITY,
- INTESTINAL FLORA ALTERATIONS,
- FOOD SENSITIVITY,
- PSYCHOLOGICAL,
- GENETIC
Diagnosis of functional bowel disorders like IBS is based on what
History
Symptoms (2) /signs (2) of IBS
Abdo pain/cramp
Abdo bloating
Altered bowel habit - mixture of both diarrhoea and constipation
Mucus in stool
IBS is often relieved by what
Defaecation
What is IBS-D
Diarrhoea predominant IBS
-muscular contractions may be stronger + more frequent
What is IBS-C
Constipation predominant IBS
-Muscular contractions reduced
What is heightened in IBS
Visceral awareness/sensitivity
What is the NICE diagnostic criteria for IBS (4)
Abdo pain relived by defection
Altered stool frequency/form
Abdo bloating
Altered stool passage
Investigations of functional bowel disorders like IBS (9) - investigations are to exclude other causes
FBC, U&Es, CRP, TFT Stool studies - culture, calprotectin (to exclude IBD) Faecal immunochemical testing (FIT) Coeliac serology - to exclude it Sigmoidoscopy - to exclude IBD or CRC Colonoscopy - to exclude IBD or CRC
Treatment of IBS (6)
Lifestyle + diet change
Laxatives - if constipation predominant (IBS-C)
Anti-diarrhoeal agents - if diarrhoea predominant (IBS-D)
Anti-spasmodics - to relive abdo pain
Tri-cyclic antidepressants
Cognitive behaviour therapy - if resistant to medical treatment
Alarm symptoms suggesting need for investigation (5)
Anorexia Loss of weight (unintentional) Anaemia Recent onset Melaena/haematemesis & Masses
Questions to ask in a history of someone presenting with functional bowel disorder (7)
What used to be normal bowel habit Bowel habit frequency Consistency of stool - loose or hard Blood in stool Mucus in stool Abdo pain/bloating
Dietary management techniques for functional bowel disorders
Use the FODMAPS (fermentable oligo-, di- and mono-saccharides and polyols) diet - collection of poorly absorbed simple and complex sugars
- reduce high FODMAP foods
- have low FODMAP alternatives
Give some low FODMAP alternatives (4)
Nut milk instead of cow milk
Carrots and lettuce instead of peas and onions
Wheat free bread
