Functional GI Disorders Flashcards
What are the two categories of GI disease?
Functional
Structural
Which category of GI disease is there more likely to be detectable pathology?
Structural GI disease
List some functional GI diseases.
Oesophageal spasm
Non-ulcer dyspepsia
Biliary dyskinesia
IBS
Slow transit constipation
Describe what happens in patients with non-ulcer dyspepsia.
Ulcer like pain but in absence of ulcer
Which part of the history is particularly important for the diagnosis of non-ulcer dyspepsia?
Family history, in particular gastric cancer or coeliac disease
Which other things are important to check if suspicious of non-ulcer dyspepsia?
H.pylori status
Alarm symptoms
If a patient is negative for H.pylori and does not have any family history or alarm symptoms, how would you treat it?
Symptomatically to relieve symptoms, usually with proton pump inhibitors
If a patient is positive for H.pylori, how would it be treated?
Eradication therapy
If there is any doubt about a patient’s symptoms concerning the diagnosis of non-ulcer dyspepsia, what can be done?
Endoscopy
What is nausea?
Sensation of feeling sick
What is retching?
Dry heaves- stomach contracts but the glottis is closed
What is vomiting?
Stomach contents expelled
What is important to ask when taking a history from someone with vomiting and nausea?
How long after eating the symptoms occur
What does it mean if sickness or vomiting usually occurs immediately after eating?
It’s psychogenic
What does it mean if sickness or vomiting usually occurs an hour or more after eating?
Pyloric obstruction
Motility disorders
What does it mean if sickness or vomiting usually occurs 12 hours after eating?
Obstruction further down the GIT
List some of the functional causes of nausea/vomiting.
Drugs
Pregnancy
Migraines
Cyclical vomiting syndrome
Alcohol
Describe the rare disorder known as cyclical vomiting disorder.
Often presents in childhood, patients get recurrent episodes of severe vomiting.
Can happen a few times a month or few times a year, usually requires hospital admission and IV fluids
Name two lower GI diseases.
IBS
Slow transit constipation
How do you assess patients on their gut function?
Ask them what is normal for them and how it has changed
What questions can we ask about stool?
Change in consistency/frequency?
Blood present- either on wiping or mixed with the stool?
Which chart may be useful for describing stool consistency?
Bristol stool chart
Describe the three parts of examination for patients who may have GIT disorders.
General examination looking for systemic disease
Abdominal examination
Rectal examination
List the Alarm symptoms for lower GIT disorders.
Age >50
Short symptom history
Nocturnal symptoms
Family history
Male
Anaemia
Rectal bleeding
Abdominal mass
List the investigations used for those with suspected lower GIT disorders.
FBC
Blood glucose
U+E’s etc
Thyroid status
Coeliac serology
FIT test
Sigmoidoscopy
What does FIT testing involve?
Checking for traces of human haemoglobin in stool
What is constipation?
When the bowel does not get properly emptied
What are some of the organic causes of constipation?
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissures
What are some of the functional causes of constipation?
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients (those who have been in hospital for a long time)
What are some of the systemic causes of constipation?
Diabetes
Hypothyroidism
Hypercalcemia
What are some of the neurogenic causes of constipation?
Autonomic neuropathies
Spina bifida
Multiple sclerosis
Parkinson’s
Strokes
What are the clinical features of IBS?
Abdominal pain
Altered bowel habit
Abdominal bloating
What do the ROME classification guidelines say about symptoms required to diagnose IBS?
Recurrent abdominal pain/discomfort for >3 days/month in past three months with two of the following-
1. Improvement w defaecation
2. Onset associated with change in stool form
3. Onset associated with change in stool frequency
Describe the abdominal pain felt in patients with IBS.
Vague
Burning
Bloating
Sharp
Occasionally radiates to lower back
Does IBS related abdominal pain occur during the day or night?
Day, nocturnal IBS pain is uncommon
What relieves IBS related pain usually?
Defaecation
What is meant by IBS-C?
Constipation predominant IBS
What is meant by IBS-D?
Diarrhoea predominant IBS
What is meant by IBS-M?
Mixed diarrhoea and constipation IBS
Bloating is a very common symptom of IBS. Describe the bloating experienced in those with IBS.
Often very prominent
Can cause wind or flatulence
What causes the bloating seen in those with IBS?
Relaxation of abdominal muscles
List some investigations used for IBS
Blood analysis
FBC
U&E, LFTs Ca
CRP
Coeliac serology
Stool culture
FIT testing
Calprotectin
Rectal examination
?Colonoscopy
What is calprotectin?
Inflammatory protein released by inflamed gut mucosa
What is calprotectin used for?
To differentiate between IBS from IBD
To monitor IBD
Are calprotectin levels raised in IBS or IBD?
IBD
Normal in IBS
What is the treatment for IBS?
Education and reassurance
Diet review
What is the FODMAP diet which is followed by some IBS patients?
Exclusion diet…idk how much you need to know in detail but helps a patient to work out if there are any triggers
Give an example of a type of drug which can help relive IBS patients of pain.
Antispasmodics
Linoclotide
Give an example of a type of drug which can help relive IBS patients of bloating.
Some probiotics
Linoclotide
Give an example of a type of drug which can help relive IBS patients of constipation.
Laxatives
Give an example of a type of drug which can help relive IBS patients of diarrhoea.
Antimotility agents
FODMAP
Name the psychological treatment options for functional GIT disorders.
Hypnotherapy
Relaxation therapy
Cognitive behavioural therapy
Psychodynamic interpersonal therapy
Describe the muscular contractions of the large intestine of those with IDB-D.
Contractions may be larger and more frequent.
Describe the muscular contractions of the large intestine of those with IDB-C.
Contractions reduced
What can trigger contractions of the large intestine?
Walking
Eating
What can happen if those who have IBS get stressed?
Their IBS becomes chronic as gut is more sensitive to stress
Which oil can be beneficial to those with IBS?
Peppermint oil
