Functional bowel disorders

Question 1

what are the 2 broad categories of GI disease?

Answer 1

structural and functional disease

Question 2

describe what a functional GI disorder is?

Answer 2

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

Question 3

describe what a structural GI disorder is?

Answer 3

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

Question 4

Give examples of some functional GI disorders? (6)

Answer 4

Oesophageal spasm

Non-Ulcer Dyspepsia (NUD)

Biliary Dyskinesia

Irritable Bowel syndrome

Slow Transit constipation

Drug related effects

Question 5

what is non-ulcer dyspepsia

Answer 5

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

Question 6

What is retching?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

Causes of functional GI disorders (5)

Answer 8

Drugs

Pregnancy

Migraine

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

Alcohol

Question 9

What is psychogenic vomiting?

Answer 9

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

Question 10

Name 2 functional diseases of the lower GI tract

Answer 10

Irritable bowel syndrome slow transit constipation

Question 11

Normal bowel habit in the West

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Alarm symptoms for a GI disease (10)

Answer 13

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

Question 14

Investigations for GI disorders (8)

Answer 14

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

Question 15

Investigations for GI disorders (8)

Answer 15

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

Question 16

organic aetiologies of constipation (5)

Answer 16

Strictures

Tumours

Diverticular disease

Proctitis

Anal fissure

Question 17

functional aetiologies of constipation (5)

Answer 17

Megacolon

Idiopathic constipation

Depression

Psychosis

Institutionalised patients

Question 18

Systemic aetiologies of constipation (3)

Answer 18

Diabetes mellitus

Hypothyroidism

Hypercalcaemia

Question 19

Neurogenic causes of constipation (5)

Answer 19

Autonomic neuropathies Parkinson’s disease Strokes Multiple sclerosis Spina bifida

Question 20

Clinical features of IBS

Answer 20

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

Question 21

What is meant by an ‘altered bowel habit’?

Answer 21

constipation diarrhoea both variability urgency

Question 22

Investigations for IBS

Answer 22

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

Question 23

What is Calprotectin?

Answer 23

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

Question 24

Difference between IBS and IBD

Answer 24

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

Question 25

Treatment for IBS

Answer 25

education diabetic review fodmap diet - avoid foods with short-chain carbs that are resistant to digestion like cows milk, apple, asparagus etc

Question 26

Drug therapy for pain associated with IBS

Answer 26

antipasmodics linaclotide

Question 27

Drug therapy for bloating associated with IBS

Answer 27

some probiotics linaclotide

Question 28

Drug therapy for constipation associated with IBS

Answer 28

laxatives - softeners, osmotics, bulking agents etc linaclotide

Question 29

Drug therapy for diarrhoea associated with IBS

Answer 29

FODMAP

Question 30

types of psychological interventions (4)

Answer 30

relaxation training hypnotherapy cognitive behavioural therapy psychodynamic interpersonal therapy

Question 31

What psychological causes are there for IBS?

Answer 31

Stress, anxiety, depression altered motility visceral hypersensitivity - over reaction of pain in organs

Question 32

what is the meaning behind IBS-C and IBS-D

Answer 32

IBS that predominantly causes diarrhoea or constipation

Question 33

intestinal motility: difference in IBS-D or IBS-C

Answer 33

In IBS-D, muscular contractions may be stronger and more frequent than normal. In IBS-C, contractions may be reduced

Question 34

heightened gut awareness

Answer 34

People with IBS often have an excessive awareness of normal digestive processes

Question 35

functional GI problems are common with low ____ but high ____

Answer 35

low mortality but high symptom impact

Question 36

Bristol stool chart

Answer 36