Functional Bowel Disorders Flashcards
What are some functional Gi disorders?
Oesophageal spasm Non-ulcer dyspepsia Biliary dyskinesia Irritable bowel syndrome Slow transit constipation Drug related effects
What is non-ulcer dyspepsia and what causes it?
Dyspeptic type pain but no ulcers
Probably due to several diseases (reflux, low grade duodenal ulceration, delayed gastric emptying, irritable bowel syndrome)
What is the cause of immediate vomiting after food?
Psychogenic
What could cause vomiting 1 or more hours after food?
Pyloric obstruction Motility disorders (diabetes, post-gastrectomy)
What could cause vomiting 12 hours after food?
Obstruction
What are the functional causes of vomiting?
Drugs Pregnancy Migraine Cyclical vomiting syndrome Alcohol
What are alarm symptoms of disease?
>50 years old Short symptom history Unintentional weight loss Nocturnal symptoms Male FH of bowel/ovarian cancer Anaemia Rectal bleeding Recent antibiotic use Abdominal mass
What investigations are done for functional bowel disorders?
FBC Blood glucose U + E Thyroid status Celiac serology FIT test Sigmoidoscopy Colonoscopy
What are the causes in organic constipation?
Strictures Tumours Diverticular disease Proctitis Anal fissure
What are the causes in functional constipation?
Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients
What are the causes in systemic constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are the causes in neurogenic constipation?
Autonomic neuropathies Parkinsons Strokes MS Spina bifida
What are the clinical features of IBS?
Abdominal pain
Altered bowel habit
Abdominal blosting
What are the investigations for IBS?
Blood analysis FBC U+E, LFTs, Ca CRP TFTs Coeliac serology Stool culture Calprotectin FIT testing Rectal examination
What is calprotectin test used for?
Differentiating IBS from IBD and for monitoring IBD
What are the treatments for IBS?
Firm diagnosis
Education and reassurance
Dietetic review
Drugs for individual symptoms - pain, bloating, constipation, diarrhoea
What are psychological interventions used for IBS?
Relaxation training
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
What causes IBS?
Altered motility
Visceral hypersensitivity
Stress/anxiety/depression
How is intestinal motility affected in IBS-D?
Muscular contractions may be stronger or more frequent that normal
How is intestinal motility affected in IBS-C?
Contractions may be reduced
How is gut response to triggers affected in IBS-D?
Response may be stronger than normal
How is gut response to triggers affected in IBS-C?
Response may be reduced
