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Mariam Alimentary > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What is the different between Functional and structural/organic GI disorders?

A

Functional:
- No detectable pathology

Structural:
- Macroscopic or microscopic detectable change in tissue

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2
Q

In what type of GI disorder are psychological effects more important?

A

Psychological factors are very important in functional disorders, particularly IBS

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3
Q

Name a few functional GI disorders?

A

Non-Ulcer Dyspepsia
Irritable Bowel Syndrome
Slow Transit Constipation
Oesophageal Spasm

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4
Q

What is non-ulcer Dyspepsia?

A

Dyspepsia without a visible cause on endoscopy

Dyspepsia is a group of symptoms:

  • Abdominal pain
  • Bloating
  • Burping
  • Nausea
  • Heartburn
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5
Q

What causes non-ulcer dyspepsia?

A

Could be:

  • Reflux
  • Delayed gastric emptying
  • An H. Pylori infection
  • IBS
  • Low level duodenal ulceration (i.e. not visible)
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6
Q

How do we diagnose Non-ulcer Dyspepsia?

A
  • Careful history & exam
  • ALARMS symptoms
  • H Pylori Test

If in doubt about whether its NUD do an endoscopy in case its not

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7
Q

What are the ALARMS symptoms?

A 
Age> 55 yrs
Loss of Weight
Anorexia/Anaemia
Recent Onset
Melaena or Haematemesis/Mass
Swallowing Difficulty

Also look out for nocturnal symptoms, rectal bleeding, recent med changes (particularly antibiotics) and a family history of bowel or ovarian cancer.

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8
Q

How do we treat NUD?

A

If H Pylori +ve treat with eradication therapy

If -ve treat the symptoms

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9
Q

Define Vomiting, Nausea and Retching?

A 
Nausea = feeling sick
Retching = Dry heaves. The antrum is contracting with closed glottis
Vomiting = Contents expelled
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10
Q

What is the chemoreceptor trigger zone?

A

An area of the medulla oblongata that receives inputs from blood-borne drugs and hormones and communicates with structures in the vomiting center to initiate vomiting

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11
Q

How does time after eating help us determine the cause of vomiting?

A

Immediate = Psychogenic

1 hour or More = Pyloric OBstruction or a motility disorder (e.g. diabetes)

12 Hours = Intestinal obstruction

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12
Q

Name some functional disorders causing of vomiting?

A
  • Drugs
  • Pregnancy
  • Migraine
  • Cyclical Vomiting Syndrome
  • Alcohol
  • Psychogenic
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13
Q

What is cyclical vomiting syndrome?

A

A rare disorder starting mainly in childhood causing recurrent episodes of vomiting
Between a few a year to a few a month
Often have to be hospitilized till they settle

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14
Q

Who is most at risk of psychogenic vomiting?

A

Young Women

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15
Q

What causes psychogenic vomiting?

A

We dont really know, possibly stress or anxiety.

Sometimes it may be self-induced, there is some overlap with bulimia

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16
Q

What are the symptoms of psychogenic vomiting?

A

Often just sudden vomiting, sometimes with nausea
Can sometimes lose weight or appetite but not often
Often stops on admission

17
Q

How do we know whats normal in terms of bowel habits?

A

We don’t as it varies massively by culture, location, diet and individual

Have to ask the patient whats changed in their frequency, color, consistency.

18
Q

What investigations should we do for someone with a change in bowel habits?

A
  • FBC
  • Blood Glucose
  • U+Es
  • Thyroid Status
  • Coeliac Serology

Can follow up with endoscopy and colonoscopy as necessary

19
Q

What are some systemic causes of constipation?

A

Diabetes
Hypothyroidism - Because without thyroid hormones the natural muscle action of the gut is slowed
Hypercalcaemia - Can lead to polyuria and dehydration and also suppress the nervous system all resulting in constipation

20
Q

What are some neurogenic causes of constipation?

A 
Autonomic neuropathies
Stroke
MS
Spina Bifida
Parkinson's Disease
21
Q

Name some organic causes of constipation?

A 
Strictures
Tumours
Diverticular Disease
Proctitis (inflammation of anus and rectal lining)
Anal Fissure
22
Q

Functional causes of constipation?

A 
Megacolon
Idiopathic Constipation
Depression
Psychosis
Being an institutionalized patient
23
Q

What are the symptoms of IBS?

A
  • Abdominal pain
  • Altered Bowel Habits
  • Abdominal Bloating
  • Heightened Gut Awareness
24
Q

Describe the abdominal pain of IBS

A

Its very variable, rarely occurs at night and is often altered by bowel movements

25
Q

What are the classes of IBS?

A

IBS-C = Constipation (May be due to reduced contractions of the bowel tube)

IBS-D = Diarrhoea (Contractions of the bowel may be stronger & faster than normal)

IBS-M = Both

26
Q

What causes the abdominal bloating of IBS and how do we assess it?

A

Seems to be due to relaxation of abdominal wall muscles which stretches the mesentery & causes bloatin/discomfort. Rather than excess gas.

Ask them to try and replicate it

27
Q

What is heightened gut awareness?

A

IBS sufferers are often excessively aware of normal digestive processes

28
Q

what are the NICE guidelines for defining IBS?

A

Abdominal pain relieved by defecation or associated with altered stool frequency/form plus two or more:

  • Altered Stool Passage
  • Abdominal bloating
  • Symptoms worsened by food
  • Passing mucous
29
Q

What tests can we do for IBS?

A

Bloods = FBC, U&E, LFT, Ca, CRP, TFTs & Coeliac serology
Stool Culture
Calprotectin
Rectal Exam & Foecal Occult Blood Test
Colonoscopy

30
Q

What is Calprotectin?

A

A protein released by inflamed gut mucosa

Useful for differentiating between IBS and IBD and then for monitoring IBD status

31
Q

How do we treat IBS?

A

Educate & Reassure
Dietetic Review
Drugs
Psychological Intervention (actually more evidence than drugs)

32
Q

What is included in an IBS dietetic review?

A
  • Avoiding laxative e.g. cafeine, alcohol and sweeteners.
  • Test lactose intolerance
  • Gluten Exclusion Trial
  • FODMAP Diet
33
Q

What is the FODMAP diet?

A

Fermentable Oligo-, Di- & Mono- saccharides and polyols.

Exclude then reintroduce one at a time to find the trigger

34
Q

What drugs are used to treat IBS?

A

Pain:

  • Anti Spasmodics
  • Anti Depressants

Bloating:

  • Some Probiotics can help with infection related IBS
  • No bulking agents of fibre

Constipation:
- Temporary Laxatives (Clears out the bowel)

Diarrhoea:
- Antimotility agents

35
Q

How do anti-depressants help with IBS?

A

They have a side effect of visceral analgesia

So we use them in small doses for the pain of IBS

36
Q

What types of psychological interventions are there for IBS?

A

Relaxation therapy - meditation & muscle relaxation to relieve stress

Hypnotherapy

Cognitive Behavioural Therapy - Identify & learn how to respond to triggers

Psychodynamic Interpersonal Therapy - Helps patients to understand how their emotions affect bowel issues (good for people with abusive childhoods)

All these need an expert psychologist to review, determine and deliver treatment

37
Q

What cause IBS?

A

Thought to be a combination of:
Altered Motility
Visceral Hypersensitivty
Stress, Anxiety and depression

The gut tube contracts in response to certain triggers including waking and eating, in IBS these responses may be increased (IBS-D) or reduced (IBS-C)

38
Q

How does stress IBS become chronic?

A

We all get nervous tummy/diarrhoea with stress.
In IBS the gut is more sensitive to stress
Stress -> IBS -> More Stress -> More IBS etc

Mariam Alimentary (43 decks)

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