Functional Bowel Disorders

Question 1

What are the 2 broad categories of GI disease?

Answer 1

Structural

Functional

Question 2

What is the difference between structural and functional GI disease?

Answer 2

Structural has detectable pathology whereas functional does not

Question 3

What are examples of functional GI disorders?

Answer 3

Oesophageal spasm

Non-ulcer dyspepsia (NUD)

Biliary dyskinesia

Irritable bowel syndrome

Slow transit constipation

Drug related effects

Question 4

What does NUD stand for?

Answer 4

Non-ulcer dyspepsia

Question 5

What do functional GI disorders have a large impact on?

Answer 5

Quality of life

Psychological factors

Question 6

What are functional GI disorders not associated with that structural disorders are?

Answer 6

Serious pathology

Question 7

What is non-ulcer dyspepsia?

Answer 7

Chronic or recurrent abdominal pain or nausea, without an ulcer

Question 8

What is the helicobacter pylori status of non-ulcer dyspepsia?

Answer 8

It varies

Question 9

What diseases i non-ulcer dyspepsia probably a combination of?

Answer 9

Reflux

Low grade duodenal ulceration

Delayed gastric emptying

Irritable bowel syndrome

Question 10

What does the diagnosis of non-ulcer dyspepsia involve?

Answer 10

Careful history and examination - FH is important

H Pylori status

Alarm symptoms

If in doubt, endoscopy

Question 11

What therapy is required for non-ulcer dyspepsia when H Pylori is positive?

Answer 11

Eradication therapy

Question 12

What is nausea?

Answer 12

The sensation of feeling sick

Question 13

What is retching?

Answer 13

Dry heaves (antrum contracts, glottis closed)

Question 14

What is vomiting?

Answer 14

Abdominal contents expelled

Question 15

What is often found in the history of nausea and vomiting immediately, 1 hour or more, 12 hours?

Answer 15

Immediate cause is psychogenic

1 hour or more is due to pyloric obstruction or motility disorders (diabetes, post gastrectomy)

12 hours or more is obstruction

Question 16

What are some functional causes of nausea and vomiting?

Answer 16

Drugs

Pregnancy

Migraine

Cyclical vomiting syndrome

Alcohol

Question 17

What is psychogenic vomiting?

Answer 17

Vomiting without any obvious organ pathology or with a psychological aetiology

Question 18

Who often suffers from psychogenic vomiting?

Answer 18

Young woman

Question 19

What often happens to psychogenic vomiting after admission?

Answer 19

It stops

Question 20

What is irritable bowel syndrome?

Answer 20

Condition of the digestive system that can cause crampls, bloating, diarrhoea and constipation

Question 21

What is slow transit constipation?

Answer 21

Reduced motility of the large intestine caused by abnormalities of the enteric nerves

Question 22

How does bowel habit from person to person vary?

Answer 22

There is a great variation in both bowel habit and stool weight

Question 23

What is the average stool weight in the UK?

Answer 23

100-200g/day

Question 24

What should be known about the interpretation of the word constipation?

Answer 24

It means different things to different people, so a better approach is to ask the patient about changes in the frequency, consistency, presence of blood or mucus from there normal

Question 25

What are alarm symptoms relating to constipation?

Answer 25

Age \>50 years Short symptoms history Unintentional weight loss Nocturnal symptoms Male sex Family history of bowel/ovarian cancer Anaemia Rectal bleeding Recent antibiotic use Abdominal mass

Question 26

What investigations should be done for slow transit constipation?

Answer 26

Colonoscopy FBC Blood glucose U + E Thyroid status Coeliac serology FIT testing Sigmoidoscopy

Question 27

What are different categories of the aetiology of constipation?

Answer 27

Systemic Neurogenic Organic Functional

Question 28

What are examples of systemic causes of constipation?

Answer 28

Diabetes mellitus Hypothyroidism Hypercalcaemia

Question 29

What are examples of neurogenic causes of constipation?

Answer 29

Autonomic neuropathies Parkinson disease Strokes Multiple sclerosis Spina bifida

Question 30

What are examples of organic causes of constipation?

Answer 30

Strictures Tumours Diverticular diseases Proctisis Anal fissure

Question 31

What are examples of functional causes of constipation?

Answer 31

Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients

Question 32

What are clinical features of irritable bowel syndrome?

Answer 32

Abdominal pain Altered bowel habit Abdominal bleeding Belching wind and flatus Mucus

Question 33

What does IBS stand for?

Answer 33

Irritable bowel syndrome

Question 34

What do NICE guidelines say is required to diagnose irritable bowel syndrome?

Answer 34

Abdominal pain/discomfort relieved by defaecation or association with altered stool frequency/form plus two or more of: altered stool passage abdominal bloating/distension symptoms made worse by eating passage of mucus

Question 35

What can be said about abdominal pain for IBS?

Answer 35

Very variable

Question 36

What are different kinds of abdominal pain that can be felt with IBS?

Answer 36

Vague Bloating Burning Sharp

Question 37

Does abdominal pain due to IBS ever radiate?

Answer 37

Occasionally, often to the lower back

Question 38

What are some examples of altered bowel habit for IBS?

Answer 38

Constipation (IBS-C) Diarrhoea (IBS-D) Both diarrhoea and constipation (IBS-M) Variability Urgency

Question 39

What symptoms often coincide with bloating?

Answer 39

Wind and flatulence Relaxation of abdominal wall muscles Mucus in stool

Question 40

What is the physical examination for IBS like?

Answer 40

Normal

Question 41

What investigations are done for IBS?

Answer 41

Blood analysis Stool culture Calprotectin FIT testing

Question 42

What causes calprotectin to be released?

Answer 42

Inflamed gut

Question 43

What is calprotectin used to differentiate?

Answer 43

IBS from IBD, and to monitor IBD

Question 44

What is the treatment for IBS?

Answer 44

Education and reassurance Dietetic review

Question 45

What is discussed in a dietetic review for IBS?

Answer 45

Tea, coffee, alcohol, sweetener Lactose, gluten exclusion trial FODMAP

Question 46

What is the FODMAPS diet?

Answer 46

Excess fructose Lactose Fructans Galactans Polyols

Question 47

What drug therapy is given for pain due to IBS?

Answer 47

Antispasmodics Linaclotide (IBS-C) Antidepressants

Question 48

What drug therapy is given for bloating due to IBS?

Answer 48

Some probiotics Linaclotide (IBS-C)

Question 49

What drug therapy is given for constipaition due to IBS?

Answer 49

Laxatives Linaclotide

Question 50

What drug therapy is given for diarrhoea due to IBS?

Answer 50

Antimotility agents FODMAP diet

Question 51

What psychological interventions can be done for IBS?

Answer 51

Relaxation training Hypnotherapy Cognitive behavioural therapy Psychodynamic interpersonal therapy

Question 52

What patients should get relaxation training for IBS?

Answer 52

Patients with diarrhoea and psychological comorbidity

Question 53

What is the mode of action of relaxation training?

Answer 53

Uses progressive muscle relaxation, biofeedback and meditation for stress relief

Question 54

What is the mode of action for hypotherapy?

Answer 54

Hypnosis induces a state of deep relaxation

Question 55

What patients with ISB should receive hypnosis?

Answer 55

Refractory patients with pain, constipation, flatulence or anxiety

Question 56

What is flatulence?

Answer 56

Build up of gas in the digestive system that leads to abdominal discomfort

Question 57

What is the mode of action of cognitive behavioural therapy?

Answer 57

Involves identifying symptom triggers and learning to respond more appropriately

Question 58

What patients with IBS is cognitive behaviour therapy useful for?

Answer 58

Ones with abdominal pain, bloating or flatulence

Question 59

What patients with IBS is cognitive behaviour therapy not effective for?

Answer 59

Ones with depression or when patients believe in a physical cause for their symptoms

Question 60

What is the mode of action of psychodynamic interpersonal therapy?

Answer 60

Helps the patient to understand how emotions and bowel syndromes interrelate

Question 61

What patients with IBS is psychodynamic interpersonal therapy useful for?

Answer 61

Patients with a history of abuse

Question 62

What patients with IBS is psychodynamic interpersonal therapy not useful for?

Answer 62

Patients with constipation, constant pain or depression

Question 63

What causes IBS?

Answer 63

Altered motility Visceral hypersensitivity Stress, anxiety, depression

Question 64

In simple terms, what is the bowel?

Answer 64

A muscular tube that squeezes content from one end to the oyther

Question 65

In what form of IBS are muscular contractions of the bowel stronger, and what form are they weaker?

Answer 65

In IBS-D muscular contractions may be stronger In IBS-C contractions may be reduced

Question 66

What is an example of gut response triggers being altered in IBS?

Answer 66

Contractions can be triggered by walking and eating

Question 67

What is the awareness of someones gut who has IBS like?

Answer 67

Excessive awareness of normal digestive processes, which most people do not feel

Question 68

How is the sensitivity of the gut due to stress in IBS different from normal?

Answer 68

The gut is more sensitive

Question 69

What can be said about mortality and qualitiy of life of functional GI problems?

Answer 69

Low mortality High impact on quality of life