Functional Bowel Disorders - Non-Ulcer Dyspepsia, Vomiting, H&E

Question 1

What is non-ulcer dyspepsia

Answer 1

Where there is dyspeptic type pain but no ulcer is found on endoscopy

Question 2

Causes of NUD

Answer 2

Often not caused by just a single disease:

• Reflux
• Low-grade duodenal ulceration
• Delayed gastric emptying
• IBS

Question 3

Diagnosis of NUD

Answer 3

History and Examination - note alarm symptoms
H. Pylori Stool Sample
Endoscopy - if all -ve but still in doubt

Question 4

Is vomiting sympathetic or parasympathetic control?

Answer 4

both sympathetic and vagal components

Question 5

Which centres control Vomiting

Answer 5

Vomiting Centre - initiates and controls emesis (smooth muscle contraction in GIT)

Chemoreceptor Triggering Zone (CTZ) - triggered by toxins or drugs

Question 6

Which kinds of toxins/drugs can trigger the CTZ

Answer 6

Opiates
Digoxin
Chemotherapy
Uraemia

Question 7

What does the length of time after eating to vomiting say about the underlying problem?

Answer 7

Immediate Vomit - psychogenic
<1 hour - pyloric obstruction or motility disorder
>12 hours - obstruction

Question 8

Functional Vomiting Causes

Answer 8

Drugs and alcohol
Pregnancy
Migraine
Cyclical Vomiting Syndrome (children)

Question 9

What is the usual presentation of psychogenic Vomiting

Answer 9

Usually young women with no preceding nausea
May be self-induced
Usually stops after admission

Question 10

With the presence of alarm symptoms, how may a functional bowel disorder be differentiated from a more serious disorder

Answer 10

In FBD, alarm symptoms tend to stop at night but if symptoms still occur at night, then suggests a worse cause

Question 11

History for functional bowel disorders

Answer 11

What is normal?
Is there change in frequency or consistency 
Blood or mucous 
Duration - from birth or recent onset
Any soling (faecal incontinence)
Drugs 
Alarm Symptoms

Question 12

What are the alarm symptoms

Answer 12

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

Question 13

Examination for FBD

Answer 13

Look for systemic disease
Abdominal examination
Rectal Examination
FOB (faecal occult blood) test

Question 14

Investigations which can be done

Answer 14

FBC
Blood glucose 
U&E
Thyroid status
Coeliac serology 

Proctoscopy
Sigmoidoscopy
Colonoscopy