functional GI disorders Flashcards

1
Q

what are functional GI disorders ?

A

a disorder compromising symptoms arising in the mid or lower GIT that are not associated with anatomic or biochemical defects

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2
Q

what are the 3 most common functional GI disorders ?

A

IBS
functional dyspepsia
constipation

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3
Q

what is irritable bowel syndrome?

A

is a GIT syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause

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4
Q

what are the subtype of IBS?

A

IBS with constipation
IBS with diarrhea
Mixed IBS
Unsubtyped IBS

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5
Q

what criteria is used for IBS?

A

Rome IV criteria

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6
Q

what is the time period required to fulfil the criteria of IBS?

A

for the past 3 months with symptom onset at least 6 months prior to diagnosis

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7
Q

what are the criteria to diagnose IBS by the Rome IV criteria ?

A
  1. abdominal pain at least once a week in the last 3 months which is associated with at least 2 of:
    - pain related to defecation
    - associated with a change in stool frequency
    - associated with a change in form of stool
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8
Q

what is the cause of the diarrhea if the diarrhea wakes the patient up?

A

organic and not functional

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9
Q

what are some alarming or atypical symptoms that are not compatible with IBS ?

A

rectal bleeding
nocturnal or progressive abdominal pain
weight loss
anemia, elevated inflammatory markers or electrolyte disturbances

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10
Q

what does the diagnostic evaluation mainly depend on ?

A

whether the predominant symptom is diarrhea or constipation

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11
Q

if the predominant symptom is diarrhea what are the diagnostic approaches ?

A

stool cultures
celiac disease screening
24 hour stool collection if malabsorption is suspected
colonscopy or flexible sigmoidoscopy

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12
Q

if the predominant symptom is constipation what are the diagnostic approaches ?

A

colonoscopy or flexible sigmoidoscopy

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13
Q

what is the treatment approach to IBS ?

A
patient education 
dietary modification n
diarrhea management 
constipation management 
pain management
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14
Q

what are some of the dietary modifications required ?

A
FODMAPs restriction 
gluten avoidance 
lactose avoidance 
food allergies testing 
dietary fibre 
and physical activity should be encouraged
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15
Q

in patients who have IBS-C and failed a trial of soluble fibre what is the next best step ion management ?

A

osmotic laxatives
chloride channel activators lubiprostone
5HT4 R

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16
Q

what is the management in patients with IBS-D?

A

anti-diarrhoea agents: loperamide
bile acid sequestrants: cholestyramine
5HT3 R antagonist: Alosetronn

17
Q

what is the side effect of alosetron ?

A

ischemic colitis

18
Q

what are the managments of pain and bloating ?

A

antispasmodics
antidepressants
probiotics rifaximin

19
Q

what is the best step in management for refractory patients?

A

behavioural therapy

fecal microbiota transplantation

20
Q

what is functional dyspepsia?

A

predominant epigastric pain lasting at least 1 month and can be associated with other symptoms such as heartburn but the primary complain is epigastric pain

21
Q

what is the best approach to a patient above the age of 60 that has dyspepsia ?

A

endoscopy should be performed

22
Q

what is the best approach to a patient below the age of 60 that has dyspepsia ?

A

H.pylori test and irradication of HP
if it is not related to H.pylori then administer PPI
if that doesn’t work then prescribe TCA
as a last resort consider psychotherapy