Functional bowel disorders Flashcards
What are the main functional bowel disorders?
Oesophageal spasm
Non-Ulcer Dyspepsia (NUD)
Biliary Dyskinesia
Irritable Bowel syndrome
Slow Transit Constipation
Drug Related Effects
Functional disorders have a good long term prognosis because there is no detectable __________
pathology
Most functional bowel disorders can be traced back to a ________ cause
psychological cause
What is Non-ulcer dyspepsia (NUD)?
Repeated Dyspepsia (indigestion) in which there is no definite organic cause
What is thought to cause non-ulcer dyspepsia?
Probably some combination of:
Reflux
Low grade duodenal ulceration
Delayed gastric emptying
Irritable bowel syndrome
If someone vomits immediately after eating, the cause is likely…
Psychogenic
What are the potential causes for vomitting 1 or more hours after eating?
Pyloric obstruction
Motility disorders such as diabetes or post gastrectomy
What would cause vomitting >12 hours after eating?
Obstruction
What are the functional causes for vomitting?
Drugs
Pregnancy
Migraine
Alcohol
Clinical vomitting syndrome
What is meant by ‘psychogenic vomitting’?
Psychogenic nausea and vomiting is defined as vomiting without any obvious organic pathology or vomiting with a psychological etiology
What are the functional bowel disorders of the lower GI tract?
Irritable bowel syndrome (IBS)
Slow transit constipation
What is the chart used to identify different types eh pooh
Bristol stool chart
What symptoms are ‘alarm bells’ and indicate a more serious illness?
Age >50
Short symptom history
Weight loss
Male
Family history
Nocturnal symptoms
Anaemia
Rectal bleeding
Recent antibiotic use
Abdominal mass
What are the possible ‘organic’ causes for constipation?
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure
What are some functional causes for constipation?
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
What are the systemic causes of constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
WHat are the neurogenic causes for constipation?
Autonomic neuropathy
Parkinson’s
Strokes
Multiple sclerosis
Spina bifida
What are the alternative names for Irritable bowel syndrome?
Spastic colon
Nervous colon
Unstable colon
Mucous colitis
What are the main clinical features of IBS?
Abdo pain (variable in character)
Altered bowel habit
Abdo bloating
Belching wind / flatulence
Mucous in stool
What sort of pain is associated with IBS?
Variable in nature (sharp, dull etc)
Relieved by defecation
Rarely occurs at night
What is the difference between IBS-C, IBS-D and IBS-M?
IBS-C = IBS with constipation
IBS-D = IBS with diarrhoea
IBS-M = IBS with diarrhoea and constipation
What examination findings would indicate IBS?
None
What is calprotectin?
Molecule released by inflamed gut mucosa
Why is calprotecting useful in the investigation of IBS?
Can be used to differentiate between IBS and IBD
What are the investigations for IBS?
Blood analysis
Stool culture
Calprotectin
FIT testing
Rectal examination?
Colonoscopy?
What is the basic treatment strategy for IBS?
Education & reassurance
Dietetic review
Drugs
What specific diet is recommended for those with IBS?
FODMAS
(Fermentable Oligo-, Di- and Mono-Saccharides and Polyols)
What drugs can be used to treat the pain in IBS?
Antispasmodics
Linaclotide (for IBS-C)
What drugs can be used to treat the bloating in IBS?
Some probiotics
Linaclotide (for IBS-C)
What drugs can be used to treat constipation for those with IBS?
Laxatives
Linaclotide
(if constipation then avoid the FODMAP diet)
What agents can be used to treat the diarrhoea in IBS-D?
Antimotility agents
FODMAP diet
What psychological interventions can be used to treat IBS?
Relaxation training
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
Relaxation therapy is especially useful for treating IBS patients with…
Diarrhoea
Psychological comorbidity
Hypnotherapy is especially useful for treating IBS patients with…
Pain
Constipation
Flatulence
Anxiety
What is cognitive behavioural therapy?
When is it most useful?
Identifying symptom triggers and learning how to respond more appropriately
Most useful for:
Abdo pain, bloating and flatulence
When is cognitive behavioural therapy not indicated?
Contraindications are:
- Depression
- Patients who believe in a physical cause for their symptoms
What is psychodynamic interpersonal therapy?
When is it useful?
Educating the patient on how their emotions and bowel symptoms interrelate
Useful for:
- A history of abuse
What are the contraindications for psychodynamic interpersonal therapy?
Constipation
Constant pain
Depression
What are possible underlying causes of IBS?
Altered motility
Visceral hypersensitivity
Stress, anxiety, depression
How would altered motility lead to IBS?
Increased motility = IBS-D
Reduced motility = IBS-C
IBS-M = get facked
