Functional Bowel Disorders Flashcards
Describe functional bowel disorders
- No detectable pathology
- Related to gut function
- Good long term prognosis
Discuss the investigation and management of a patient with a functional bowel disorder
a
Understand impact of functional bowel disorders and role of psychological factors
a
Discuss alarm symptoms suggesting need for investigation
a
Discuss drug, dietary and other management techniques for functional bowel disorders
a
Compare and contrast pathophysiological causes of abdominal swelling and outline relevant investigations
a
Describe the aetiology, presentation and management of intestinal obstruction
a
Describe the presentation, investigation and treatment of non-ulcer dyspepsia.
Presentation: dyspeptic-like pain.
Investigation: detailed history, alarms symptoms –> endoscopy.
Treatment: if all investigations negative, treat symptomatically.
List the functional causes of nausea and vomiting.
- Drugs
- Pregnancy
- Migraine
- Cyclical Vomiting Syndrome
- Alcohol
Describe the epidemiology and presentation of psychogenic vomiting.
- Often younger women
- Many years, no preceding trauma
- May be self-induced (bulimia)
- Appetite not disturbed
- May be weight loss
- Often stops shortly after admission
List the alarm symptoms for GI issues.
- > 50 years
- Short symptom history
- Unintentional weight loss
- Nocturnal symptoms
- Male
- Family history of GI cancer
- Anaemia
- Rectal bleeding
- Recent antibiotic use
- Abdominal mass
List the causes of functional constipation.
- Megacolon
- Idiopathic
- Depression
- Psychosis
Describe the presentation of irritable bowel syndrome (IBS).
- Abdominal pain: variable, can radiate, rarely at night
- Altered bowel habit
- Abdominal bloating
- Belching and flatus
- Mucus
Occurs in a chronic relapsing, remitting pattern.
Describe the investigation of IBS.
- Bloods
- Stool culture
- Calprotectin: produced in IBD, not IBS
- FIT testing
Describe the treatment of IBS.
- Firm diagnosis
- Education and reassurance
- Dietetic review: lactose/gluten exclusion trial, FODMAP
What is the appropriate investigation if a patient presents with GI symptoms and alarm symptoms?
Upper: endoscopy
Lower: colonoscopy
List drugs used to treat the symptoms of functional bowel disorders.
Pain: antispasmodics, antidepressants. Bloating: some probiotics. Constipation: laxatives, Diarrhoea: anti-motility agents. HOWEVER, drugs do not work well in functional disorders.
List the psychological interventions that can be used in functional bowel disorders.
- Relaxation training
- Hypnotherapy
- Cognitive behavioural therapy
- Psychodynamic interpersonal therapy
Describe how gut response is altered in IBS.
- Muscular contractions stronger and more frequent in IBS-D, and vice versa in IBS-C
- Triggers also stronger in IBS-D
- IBS sufferers have excessive gut awareness
- Gut is more sensitive to stress and response can become chronic
