Functional Disorders Flashcards
What are the two main plexi that innervate the gut? Where are they located?
Enteric Nervous System
Submucosal plexi - Between submucosa and circular muscle
Myenteric - Between the circular and longitudinal muscle layers
What are the main nervous system input that innervate the plexi of th gut?
Sympathetic and parasympathetic fibers – interact with the myenteric and submucosal plexi
Main neurotransmitters for the gut is 5HT – serotonin
Extra - what is faecal calprotectin? Why is it useful?
Faecal calprotectin is a very sensitive marker for inflammation in the gastrointestinal tract, and useful for the differentiation of inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS).
What is the criteria for IBS?
IBS is common - main reason for referral to GI clinics
Rome IV Criteria
Abdominal pain
AND
2 of:
* Related to defaecation
* Change in stool frequency
* Change in stool form
Symptoms over the last 6 months
On average weekly for last 3 months
How can we explain the pathophysiology of IBS?
No underlying pathology found in the gut
- Abnormal brain-gut interaction - leading to an uncoordinated action - resulting in symptoms
- Visceral hypersensitivity - low pain tolerance
What are the different subtypes of IBS?
IBS-C - constipation
IBS-D - diarrhea
IBS-M - mixed
IBS-U - unsubtyped
What symptoms are associated with IBS?
SYMPTOMS
* Onset following gastroenteritis
* Post-prandial urgency
* Alternating diarhoea/constipation
* Passing mucus
* Sensation of incomplete evacuation
* Abdominal bloating
* Abdominal distention
What other conditions are associated with IBS?
OTHER CONDITIONS
* Migraine
* Dyspepsia
* Dyspareunia - difficult/painful sexual intercourse
* Bladder problems
* Fibromyalgia - widespread musculoskeletal pain
* Chronic fatigue
What are some alarm features when taking an IBS history?
- Weight loss
- Rectal bleeding,
- Anaemia, thrombocytosis
- Persistent diarrhoea (lack of day-day variability)
- New onset over 50 yrs
- Frequent nocturnal symptoms
- FHx bowel cancer/IBD
What management is used for IBS?
First line treatment – lifestyle (exercise) and 1st line dietary advise
Followed by…
* Diet – Low FODMAP diets, restriction lactose and wheat/gluten
* Drug therapy – predominant symptomatic
* Psychological therapies - CBT, hypotherapy, relacation therapy
What drugs are used to help with pain and bloating associated with IBS?
What drugs are used to help with diarrhea associated with IBS?
What drugs are used to help with constipation associated with IBS?
What differential diagnosis could you make for the following patient case? What investigations would you order? What is the probable diagnosis if all tests for organic disease come back normal?
Note - Exclude other systemic or metabolic disease – e.g. diabetes can cause autonomic dysfunction of the gut
Probable diagnosis:
Functional or non-ulcer dyspepsia -Uncomplicated dyspepsia ( non alarm symptoms)
What are the four main types of functional gastrointestinal disorders?
What is the pathophysiology of functional dyspepsia?
Abnormal brain-gut interaction resulting in…
* Decreased fundic accommodation – not increasing in size
* Abnormal motility and distribution of gastric contents
* Delayed emptying
* Anxiety and stress make these symptoms worse
