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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
Associations of bloating
Wind and flatulence Relaxation of abdominal wall muscles Mucus in stool Upper and other GI symptoms
26
Examples of functional diseases of the lower GI tract
Irritable bowel syndrome | Slow transit constipation
27
Stool weight in the UK
100-200g / day
28
What else should be asked in relation to gut function?
What is normal for you? Change in frequency Blood Mucus
29
Examples of altered bowel habits
``` Constipation (IBS - C) Diarrhoea (IBS - D) Both diarrhoea and constipation (IBS - M) Variability Urgency ```
30
What type of chart is used to analyse stools?
Bristol stool chart
31
What are types in the Bristol stool chart?
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
What types of the Bristol stool chart are considered normal?
Type 3 or 4
33
Investigations of functional bowel symptoms
``` FBC Glucose U and Es Thyroid status Coeliac serology Proctoscopy Sigmoidoscopy Colonoscopy ```
34
NICE criteria for diagnosing IBS
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
Investigations for IBS
``` Compatible history NORMAL examination FBC U and E LFTS Ca CRP TFTs Coeliac serology Stool culture Calprotectin Rectal exam and FOB Possible colonoscopy ```
36
What releases calprotectin?
Inflamed gut mucosa
37
What differentiates IBS from IBD, and also monitors IBD?
Calprotectin
38
Presentation of IBS
``` Abdominal pain Altered bowel habit Abdominal bloating Belching wind and flatus Mucus ```
39
Causes of IBS
``` Altered motility Visceral hypersensivity Stress Anxiety Depression ```
40
Pathology of IBS-D
Muscular contractions in the bowel may be stronger and more frequent than normal
41
Pathology of IBS-C
Muscular contractions may be reduced and less frequent than normal
42
What can contractions in IBS be triggered by?
Walking | Eating
43
How does the brain perceive messages from the gut in IBS?
Hears the messages too loudly | Therefore heightened gut awareness
44
Alarm symptoms in functional bowel symptoms needing investigation
``` 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
Treatment of functional bowel disorders
``` 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
What can be used to treat pain of functional bowel symptoms?
``` Antispasmodics Linaclotide (IBS-C) Antidepressants - TCAs (IBS-D) - SSRIs (IBS-C) ```
47
What can be used to treat bloating?
Some probiotics Linaclotide (IBS-C) Avoid; bulking agents/fibre
48
What can be used to treat constipation?
``` Laxatives - bulking agents/fibre (episodic) - softeners (adjuvants) - stimulants (occasional) - osmotics (regular) Linaclotide Avoid - TCAs - FODMAP ```
49
What can be used to treat diarrhoea in IBS?
Antimotility agents FODMAP diet Avoid - SSRIs
50
What is relaxation training therapy particularly effective in?
Diarrhoea | Psychological comorbidity
51
What is hypnotherapy useful in treating?
Can help manage refractory / hard to treat patients - pain - constipation - flatulence - anxiety
52
What is CBT effective for?
Abdominal pain Bloating Flatulence
53
What does CBT do in terms of IBS?
Identifies symptom triggers and learns how to respond more appropriately
54
Causes of constipation
``` 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
Definition of proctitis
Inflammation of the rectum
56
What is cyclical vomiting syndrome associated with?
Migraines
57
Presentation of cyclical vomiting syndrome
``` 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
Treatment of cyclical vomiting syndrome
``` Avoidance of triggers Prophylaxis - Amitriptyline - Propanolol - Topiramate Acute episodes - Ondansteron - Procholrperazine - Triptans ```
59
Is weight loss a feature of IBS?
No
60
Brand name for loperamide
Immodium

Gastrointestinal Pathology (26 decks)

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