Functional Bowel Disorders Flashcards
What is a functional bowel disorder?
No detectable pathology
What is non-ulcer dyspepsia?
Dyspeptic type pain with no ulcer on endoscopy
h.pylori status variable
Diagnosis of non-ulcer dyspepsia? (3)
History + exam (inc. FH)
H.pylori status
ALARM symptoms
How to treat non-ulcer dyspepsia if:
a) all tests negative
b) H.pylori positive
c) if doubt
a) symptomatic treatment
b) eradication therapy
c) endoscopy
What is nausea?
the sensation of feeling sick
What is retching?
Dry heave
Antrum contracts, glottis closed
What is vomiting?
Contents expelled
What is the most likely diagnosis if N&V immediately from food?
Psychogenic vomiting
What group is most likely to have psychogenic vomiting?
Young women
What are the likely diagnoses if nausea and vomiting 1 hr or more after food? (2)
Pyloric obstruction
Motility disorders
What is most likely diagnosis if nausea & vomiting 12 hours or more after food?
Obstruction
Name 5 functional causes
Drugs Pregnancy Migraine (abdominal) Cyclical vomiting syndrome Alcohol
5 clinical features of IBS
Abdominal pain Altered bowel habit Abdominal bleeding Belching wind & flatus/bloating Mucus in stools
Description of abdominal pain associated with IBS (4)
variable (vague, bloating, burning, sharp)
Replicated by balloon inflation
Occasionally radiates (often lower back)
Rarely occurs at night
What defines IBS-C?
Constipation
What defines IBS-D?
Diarrhoea
What defines IBS-M?
Constipation & diarrhoea
What diagnoses IBS?
History + normal exam
Investigations in IBS? (6)
Blood analysis (check coeliac) Stool culture Calprotectin FIT testing Rectal examination Colonoscopy?
What is FIT testing?
Faecal Immunochemical Test
Treatment of IBS?
Firm diagnosis Education & reassurance Dietetic review Tea, coffee, alcohol, sweetener Lactose, gluten exclusion trial FODMAP
Treatment for IBS pain? (3)
Antispasmodics
Linaclotide (IBS-C)
Antidepressants
Treatment for IBS bloating? (2)
Some probiotics
Linaclotide (IBS-C)
What is IBS?
Functional bowel disorder with visceral hypersensitivity where the sensory nerve endings have an abnormally strong response to stimuli
Signs of IBS? (2)
Abdominal tenderness
Mucus in stool
Symptoms of IBS? (3)
Excess gas
Abdominal pain
Diarrhoea/Constipation
Treatment for IBS constipation? (2)
Laxatives
Linaclotide
Treatment for IBS diarrhoea? (2)
Antimotility agents
FODMAP
Psychological interventions for IBS? (4)
Relaxation training
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
Investigations for slow transit constipation? (8)
FBC Blood Glc U+E Thyroid status (in hypothyroid gut slows down) Coeliac serology FIT testing Sigmoidoscopy Colonoscopy
Systemic causes of constipation? (3)
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
Neurogenic causes of constipation? (5)
Autonomic neuropathies Parkinson's disease Strokes MS Spina bifida
Organic causes of constipation? (5)
Strictures Tumours Diverticular disease Proctitis Anal fissure
Functional causes of constipation? (5)
Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients
