Functional bowel disorders Flashcards
what are the 2 broad categories of GI disease?
structural and functional disease
describe what a functional GI disorder is?
Related to gut function no detectable pathology long term prognosis is good
describe what a structural GI disorder is?
Has a detectable pathology e.g macroscopic - cancer or microscopic - colitis Prognosis depends on the pathology
Give examples of some functional GI disorders? (6)
Oesophageal spasm
Non-Ulcer Dyspepsia (NUD)
Biliary Dyskinesia
Irritable Bowel syndrome
Slow Transit constipation
Drug related effects
what is non-ulcer dyspepsia
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
What is retching?
dry heaves Antrum of the stomach contracts but the glottis is closed - contents are note expelled
What is the meaning of vomiting after food: 1. immediately 2. 1 hour or more 3. 12 hours
Immediately - psychogenic 1 hour or more - pyloric obstruction or motility disorders like diabetes 12 hours - obstruction
Causes of functional GI disorders (5)
Drugs
Pregnancy
Migraine
Cyclical Vomiting Syndrome - Onset often in childhood - Recurrent episodes 2-3 x year – 2-3 x month
Alcohol
What is psychogenic vomiting?
vomiting without any obvious organic pathology often young women and can be an ongoing problem - for years
Name 2 functional diseases of the lower GI tract
Irritable bowel syndrome slow transit constipation
Normal bowel habit in the West
1 stool per day - normal - 100-200g/day 3 per day may be viewed as diarrhoea
What is a better approach than a generic definition of constipation?
to consider changes in Gut function for that individual - change in freq, consistency blood? mucus?
Alarm symptoms for a GI disease (10)
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
Investigations for GI disorders (8)
FBC Blood glucose U + E, etc. Thyroid status Coeliac serology FIT testing Sigmoidoscopy Colonoscopy
Investigations for GI disorders (8)
FBC Blood glucose U + E, etc. Thyroid status Coeliac serology FIT testing Sigmoidoscopy Colonoscopy
organic aetiologies of constipation (5)
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure
functional aetiologies of constipation (5)
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
Systemic aetiologies of constipation (3)
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
Neurogenic causes of constipation (5)
Autonomic neuropathies Parkinson’s disease Strokes Multiple sclerosis Spina bifida
Clinical features of IBS
Abdominal pain - can be variable - bloating, burning, sharp - can radiate to lower back Altered bowel habit Abdominal bloating belching wind and flatus, mucus
What is meant by an ‘altered bowel habit’?
constipation diarrhoea both variability urgency
Investigations for IBS
Blood analysis - FBC, U&E, LFT + Ca stool culture calprotectin FIT testing rectal examination ? colonoscopy
What is Calprotectin?
protein released by inflamed gut mucosa used to differentiate IBS from IBD and for monitoring IBD
Difference between IBS and IBD
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
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
Drug therapy for pain associated with IBS
antipasmodics linaclotide
Drug therapy for bloating associated with IBS
some probiotics linaclotide
Drug therapy for constipation associated with IBS
laxatives - softeners, osmotics, bulking agents etc linaclotide
Drug therapy for diarrhoea associated with IBS
FODMAP
types of psychological interventions (4)
relaxation training hypnotherapy cognitive behavioural therapy psychodynamic interpersonal therapy
What psychological causes are there for IBS?
Stress, anxiety, depression altered motility visceral hypersensitivity - over reaction of pain in organs
what is the meaning behind IBS-C and IBS-D
IBS that predominantly causes diarrhoea or constipation
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
heightened gut awareness
People with IBS often have an excessive awareness of normal digestive processes
functional GI problems are common with low ____ but high ____
low mortality but high symptom impact
Bristol stool chart
