Functional bowel disorders Flashcards

1
Q

what are the 2 broad categories of GI disease?

A

structural and functional disease

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2
Q

describe what a functional GI disorder is?

A

Related to gut function no detectable pathology long term prognosis is good

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3
Q

describe what a structural GI disorder is?

A

Has a detectable pathology e.g macroscopic - cancer or microscopic - colitis Prognosis depends on the pathology

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4
Q

Give examples of some functional GI disorders? (6)

A

Oesophageal spasm

Non-Ulcer Dyspepsia (NUD)

Biliary Dyskinesia

Irritable Bowel syndrome

Slow Transit constipation

Drug related effects

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5
Q

what is non-ulcer dyspepsia

A

Variety of upper GI symptoms without ulcers on Endoscopy

H. pylori status varies

Probably not a single disease.

Could have reflux, low grade duodenal ulceration, delayed Gastric emptying or irritable bowel syndrome

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6
Q

What is retching?

A

dry heaves Antrum of the stomach contracts but the glottis is closed - contents are note expelled

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7
Q

What is the meaning of vomiting after food: 1. immediately 2. 1 hour or more 3. 12 hours

A

Immediately - psychogenic 1 hour or more - pyloric obstruction or motility disorders like diabetes 12 hours - obstruction

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8
Q

Causes of functional GI disorders (5)

A

Drugs

Pregnancy

Migraine

Cyclical Vomiting Syndrome - Onset often in childhood - Recurrent episodes 2-3 x year – 2-3 x month

Alcohol

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9
Q

What is psychogenic vomiting?

A

vomiting without any obvious organic pathology often young women and can be an ongoing problem - for years

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10
Q

Name 2 functional diseases of the lower GI tract

A

Irritable bowel syndrome slow transit constipation

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11
Q

Normal bowel habit in the West

A

1 stool per day - normal - 100-200g/day 3 per day may be viewed as diarrhoea

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12
Q

What is a better approach than a generic definition of constipation?

A

to consider changes in Gut function for that individual - change in freq, consistency blood? mucus?

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13
Q

Alarm symptoms for a GI disease (10)

A

Age >50

Short symptom history

Unintentional weight loss

Nocturnal symptoms

Male>female

Family history of bowel/ovarian cancer

Anaemia

Rectal bleeding

Recent antibiotic use

Abdominal mass

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14
Q

Investigations for GI disorders (8)

A

FBC Blood glucose U + E, etc. Thyroid status Coeliac serology FIT testing Sigmoidoscopy Colonoscopy

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15
Q

Investigations for GI disorders (8)

A

FBC Blood glucose U + E, etc. Thyroid status Coeliac serology FIT testing Sigmoidoscopy Colonoscopy

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16
Q

organic aetiologies of constipation (5)

A

Strictures

Tumours

Diverticular disease

Proctitis

Anal fissure

17
Q

functional aetiologies of constipation (5)

A

Megacolon

Idiopathic constipation

Depression

Psychosis

Institutionalised patients

18
Q

Systemic aetiologies of constipation (3)

A

Diabetes mellitus

Hypothyroidism

Hypercalcaemia

19
Q

Neurogenic causes of constipation (5)

A

Autonomic neuropathies Parkinson’s disease Strokes Multiple sclerosis Spina bifida

20
Q

Clinical features of IBS

A

Abdominal pain - can be variable - bloating, burning, sharp - can radiate to lower back Altered bowel habit Abdominal bloating belching wind and flatus, mucus

21
Q

What is meant by an ‘altered bowel habit’?

A

constipation diarrhoea both variability urgency

22
Q

Investigations for IBS

A

Blood analysis - FBC, U&E, LFT + Ca stool culture calprotectin FIT testing rectal examination ? colonoscopy

23
Q

What is Calprotectin?

A

protein released by inflamed gut mucosa used to differentiate IBS from IBD and for monitoring IBD

24
Q

Difference between IBS and IBD

A

IBS usually causes no ulcers or lesions in the bowel, and it involves only the colon. The most common forms of IBD are ulcerative colitis (UC) and Crohn’s disease

25
Treatment for IBS
education diabetic review fodmap diet - avoid foods with short-chain carbs that are resistant to digestion like cows milk, apple, asparagus etc
26
Drug therapy for pain associated with IBS
antipasmodics linaclotide
27
Drug therapy for bloating associated with IBS
some probiotics linaclotide
28
Drug therapy for constipation associated with IBS
laxatives - softeners, osmotics, bulking agents etc linaclotide
29
Drug therapy for diarrhoea associated with IBS
FODMAP
30
types of psychological interventions (4)
relaxation training hypnotherapy cognitive behavioural therapy psychodynamic interpersonal therapy
31
What psychological causes are there for IBS?
Stress, anxiety, depression altered motility visceral hypersensitivity - over reaction of pain in organs
32
what is the meaning behind IBS-C and IBS-D
IBS that predominantly causes diarrhoea or constipation
33
intestinal motility: difference in IBS-D or IBS-C
In IBS-D, muscular contractions may be stronger and more frequent than normal. In IBS-C, contractions may be reduced
34
heightened gut awareness
People with IBS often have an excessive awareness of normal digestive processes
35
functional GI problems are common with low ____ but high \_\_\_\_
low mortality but high symptom impact
36
Bristol stool chart