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Gastrointestinal Pathology > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What are the 2 broad categories of GI disease?

A

Structural

Functional

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2
Q

Definition of a functional disorder

A

No detectable pathology but symptoms present

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3
Q

Prognosis of a functional disorder

A

Good

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4
Q

Examples of 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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5
Q

Presentation of non ulcer dyspepsia

A

Dyspeptic type pain
No ulcers on endoscopy
H pylori status varies

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6
Q

Possible causes of non ulcer dyspepsia - probably not a single disease

A

Reflux
Low grade duodenal ulceration
Delayed gastric emptying
IBS

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7
Q

Investigations of non ulcer dyspepsia

A

FH
H pylori status
Alarm symptoms
Endoscopy if in doubt

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8
Q

Treatment of non ulcer dyspepsia

A

Treat symptomatically

Eradication therapy if have H pylori

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9
Q

What age is gastric cancer rare?

A

< 45 y/o

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10
Q

Definition of nausea

A

The sensation of feeling sick

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11
Q

Definition of retching

A

Dry heaves

Antrum contracts, glottis closed

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12
Q

Definition of vomiting

A

Contents expelled

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13
Q

What controls vomiting and nausea?

A

Sympathetic and vagal components
Vomiting centre
Chemoreceptor trigger zone (CTZ)
-

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14
Q

What does the chemoreceptor trigger zone have receptors for?

A

Opiates
Digoxin
Chemotherapy
Uraemia

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15
Q

Vomiting immediately after food would indicate what?

A

Psychogenic problem

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16
Q

Vomiting 1 hour or more after food would indicate what?

A

Pyloric obstruction
Motility disorders
- DM
- post gastrectomy

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17
Q

Vomiting 12 hours or more after food would possibly indicate what?

A

Obstruction etc

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18
Q

Functional causes of nausea and vomiting

A 
Drugs
Pregnancy 
Migraine
Cyclical vomiting syndrome
Alcohol
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19
Q

What is cyclical vomiting syndrome?

A

Recurrent episodes 2-3 x a year - 2 - 3 x a month

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20
Q

When is the onset often of cyclical vomiting syndrome?

A

Childhood

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21
Q

Who often gets psychogenic vomiting?

A

Young women

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22
Q

Different types of abdominal pain

A

Vague
Bloating
Burning
Sharp

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23
Q

How common is it for abdominal pain to occur at night?

A

Rare

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24
Q

What is abdominal pain often altered by?

A

Bowel action

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25
Q

Associations of bloating

A

Wind and flatulence
Relaxation of abdominal wall muscles
Mucus in stool
Upper and other GI symptoms

26
Q

Examples of functional diseases of the lower GI tract

A

Irritable bowel syndrome

Slow transit constipation

27
Q

Stool weight in the UK

A

100-200g / day

28
Q

What else should be asked in relation to gut function?

A

What is normal for you?
Change in frequency
Blood
Mucus

29
Q

Examples of altered bowel habits

A 
Constipation (IBS - C)
Diarrhoea (IBS - D)
Both diarrhoea and constipation (IBS - M)
Variability
Urgency
30
Q

What type of chart is used to analyse stools?

A

Bristol stool chart

31
Q

What are types in the Bristol stool chart?

A

Type 1 - separate hard lumps, like nuts
Type 2 - sausage shaped, a bit lumpy
Type 3 - Like a sausage or a snake, but with cracks on its surface
Type 4 - Like a sausage or a snake, smooth and oft
Type 5 - soft blobs with clear cut edges
Type 6 - fluffy pieces with ragged edges, a mushy stool
Type 7 - watery, no solid pieces

32
Q

What types of the Bristol stool chart are considered normal?

A

Type 3 or 4

33
Q

Investigations of functional bowel symptoms

A 
FBC
Glucose
U and Es
Thyroid status
Coeliac serology 
Proctoscopy 
Sigmoidoscopy
Colonoscopy
34
Q

NICE criteria for diagnosing IBS

A

Abdominal pain / discomfort relieved by defeacation or assosiated with altered stool frequency/form, plus 2 or more of

  • altered stool passage
  • abdominal bloating/distention
  • Symptoms made worse by eating
  • passage of mucus
35
Q

Investigations for IBS

A 
Compatible history 
NORMAL examination 
FBC
U and E
LFTS
Ca
CRP
TFTs
Coeliac serology 
Stool culture
Calprotectin 
Rectal exam and FOB
Possible colonoscopy
36
Q

What releases calprotectin?

A

Inflamed gut mucosa

37
Q

What differentiates IBS from IBD, and also monitors IBD?

A

Calprotectin

38
Q

Presentation of IBS

A 
Abdominal pain 
Altered bowel habit
Abdominal bloating
Belching wind and flatus 
Mucus
39
Q

Causes of IBS

A 
Altered motility
Visceral hypersensivity
Stress
Anxiety
Depression
40
Q

Pathology of IBS-D

A

Muscular contractions in the bowel may be stronger and more frequent than normal

41
Q

Pathology of IBS-C

A

Muscular contractions may be reduced and less frequent than normal

42
Q

What can contractions in IBS be triggered by?

A

Walking

Eating

43
Q

How does the brain perceive messages from the gut in IBS?

A

Hears the messages too loudly

Therefore heightened gut awareness

44
Q

Alarm symptoms in functional bowel symptoms needing investigation

A 
Age > 50 
Short symptom history 
Unintentional weight loss
Nocturnal symptoms
Male sex
FH of bowel / ovarian cancer
Anaemia
Rectal bleeding
Recent antibiotic use
Abdominal mass
45
Q

Treatment of functional bowel disorders

A 
Dietic review
- avoid tea, coffee, alcohol, sweetener 
- lactose and gluten exclusion trial 
- FODMAP diet 
Reassurance 
Treatment of symptoms
Psychological interventions
- Relaxation training therapy
- Hypnotherapy 
- CBT
- Psychodynamic interpersonal therapy
46
Q

What can be used to treat pain of functional bowel symptoms?

A 
Antispasmodics
Linaclotide (IBS-C)
Antidepressants
- TCAs (IBS-D)
- SSRIs (IBS-C)
47
Q

What can be used to treat bloating?

A

Some probiotics
Linaclotide (IBS-C)
Avoid; bulking agents/fibre

48
Q

What can be used to treat constipation?

A 
Laxatives
- bulking agents/fibre (episodic)
- softeners (adjuvants)
- stimulants (occasional) 
- osmotics (regular) 
Linaclotide 
Avoid
- TCAs
- FODMAP
49
Q

What can be used to treat diarrhoea in IBS?

A

Antimotility agents
FODMAP diet
Avoid - SSRIs

50
Q

What is relaxation training therapy particularly effective in?

A

Diarrhoea

Psychological comorbidity

51
Q

What is hypnotherapy useful in treating?

A

Can help manage refractory / hard to treat patients

  • pain
  • constipation
  • flatulence
  • anxiety
52
Q

What is CBT effective for?

A

Abdominal pain
Bloating
Flatulence

53
Q

What does CBT do in terms of IBS?

A

Identifies symptom triggers and learns how to respond more appropriately

54
Q

Causes of constipation

A 
DM
Hypothyroidism 
Hypercalcaemia
Autonomic neuropathies
Parkinsons
Strokes
MS
Spina bifida
Strictures
Tumours 
Diverticular disease
Proctitis 
Anal fissure
Megacolon 
Depression 
Idiopathic constipation 
Psychosis 
Institutionalised patients
55
Q

Definition of proctitis

A

Inflammation of the rectum

56
Q

What is cyclical vomiting syndrome associated with?

A

Migraines

57
Q

Presentation of cyclical vomiting syndrome

A 
Severe N + V lasting hours to days
Prodromal intense sweating and nausea
Well in between episodes
Also may have
- weight loss
- reduced apetite
- abdo pain 
- diarrhoea
- dizziness
- photophobia
- headache
58
Q

Treatment of cyclical vomiting syndrome

A 
Avoidance of triggers
Prophylaxis
- Amitriptyline
- Propanolol 
- Topiramate
Acute episodes
- Ondansteron 
- Procholrperazine
- Triptans
59
Q

Is weight loss a feature of IBS?

A

No

60
Q

Brand name for loperamide

A

Immodium

Gastrointestinal Pathology (26 decks)

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