Functional Bowel Disorders Flashcards
what are the 2 broad categories of GI disorders?
structural and functional
what is the structural GI disorders?
Detectable pathology Macroscopic e.g. a Cancer Microscopic e.g. Colitis Usually Both Prognosis depends on pathology
what is the functional GI disorders?
No detectable pathology
Related to gut function
“Software faults”
Long-term prognosis good
what are the functional GI disorders?
Oesophageal spasm Non-Ulcer Dyspepsia (NUD) Biliary Dyskinesia Irritable Bowel syndrome Slow Transit Constipation Drug Related Effects
what diseases can non-ulcer dyspepsia lead to?
reflux, low grade duodenal ulceration, delayed gastric emptying and irritable bowel syndrome
if any doubt of non ulcer dyspepsia what should you perform?
endoscopy
functional causes of non ulcer dyspepsia
Drugs Pregnancy Migraine Cyclical Vomiting Syndrome Onset often in childhood Recurrent episodes 2-3 x year – 2-3 x month Alcohol
whatare the functional diseases of lower GI tract?
IBS
slow transit constipation
what is considered normal bowel habits in the west?
1 stool per day is often considered normal
3 per day may be viewed as diarrhoea
what is considered normal bowel habits in senegal
2 stools per day is normal
1 per day is constipated
normal stool weight in uk
100-200g/ day
symptoms of diseases of lower GI tract
over 50 unintentional weight loss male noccturnal symptoms family history of bowel cancer anaemia rectal bleeding recent antibiotic use abdominal mass
investigations for lower GI disease
FBC Blood glucose U + E, etc. Thyroid status Coeliac serology FIT testing Sigmoidoscopy colonoscopy
aetiology of constipation
Diabetes mellitus Hypothyroidism Hypercalcaemia Autonomic neuropathies Parkinson's disease Strokes Multiple sclerosis Spina bifida
clinical features of IBS
Abdominal pain Altered bowel habit Abdominal bloating Belching wind and flatus mucus
what are the types of altered bowel habits?
Constipation (IBS-C) Diarrhoea (IBS-D) Both diarrhoea and constipation (IBS-M) Variability Urgency
investigation of IBS
Blood analysis FBC U & E, LFTs, Ca CRP TFTs Coeliac serology Stool Culture Calprotectin FIT testing Rectal Examination ?Colonoscopy
what releases calprotectin?
inflamed gut mucosa
what is used for differentiating IBS and IBD?
calprotectin
treatment of IBS
A firm diagnosis Education and reassurance Dietetic review Tea, coffee, alcohol, sweetener Lactose, gluten exclusion trial FODMAP
drug therapy for IBS for pain
antispasmodics
linaclotide
antidepressants
drug therapy for IBS- bloating
some probiotics
linaclotide
avoid bulking agents
drug therapy for IBS- constipation
laxiti es
linaclotide
avoid TCAs, FODMAP
what is the mode of action for relaxation training?
uses progressive muscle relaxation, biofeedback, and meditation for stress relief
what are the type of patients that would undergo relaxation training?
particularly effective in patients with: diarrhoea
psychological comorbidity
whats the mode of actin for hypnotherapy?
hypnosis induces a state of deep relaxation
what type of patients are likely to undergo hypnotherapy
patients with pain
constipation
flatulence
anxiety
what is the mode of action for cognitive behavioural therapy
involves identifying symptom triggers and learning to respond more appropriately
what tye of patients are likely to undergo cognitive behavioural therapy?
effective for abdominal pain, bloating, flatulence
not effective for depression or when patients believe in a physical cause for their symptoms
what is the mode of action for psychodynamic interpersonal therapy
helps the patient to undersstand how emotions and bowel symptoms interrelate
what type of patients undergo psychodynamic interpersonal therapy
particularly effective in patients with a history of abuse
less effective for patients with constipation
constant pain
depression
what causes IBS
altered motility
visceral hypersensitivity
stress, anxiety, depression
what is the bowel?
muscular tube that squeezes content from one end to the other
contractions of the bowel can be triggered by…
waking and eating
true or false: the brain hears the gut too loudly in IBS
true
does having IBS have a heightened gut awareness or less?
heightened
