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Functional GI disorders Flashcards

1
Q

What are the 2 broad categories of GI disease?

A

Structural

Functional

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2
Q

What is the difference between structural and functional GI disease?

A

Structural has detectable pathology whereas functional does not

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3
Q

what are the different types of structural detectable pathologies?

A

Macroscopic e.g. a Cancer
Microscopic e.g. Colitis

Usually Both
Prognosis depends on pathology

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4
Q

what are functions GI disorders related to?

A

gut function

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5
Q

how is the prognosis for a functional GI disorder?

A

Long-term prognosis good

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6
Q

What are examples of functional GI disorders?

A

Oesophageal spasm

Non-ulcer dyspepsia (NUD)

Biliary dyskinesia

Irritable bowel syndrome

Slow transit constipation

Drug related effects

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7
Q

What does NUD stand for?

A

Non-ulcer dyspepsia

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8
Q

What do functional GI disorders have a large impact on?

A

Quality of life

Psychological factors

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9
Q

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

A

Serious pathology

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10
Q

What is non-ulcer dyspepsia?

A

Chronic or recurrent abdominal pain or nausea, without an ulcer

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11
Q

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

A

It varies

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12
Q

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

A

Reflux

Low grade duodenal ulceration

Delayed gastric emptying

Irritable bowel syndrome

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13
Q

What does the diagnosis of non-ulcer dyspepsia involve?

A

Careful history and examination - FH is important

H Pylori status

Alarm symptoms

If in doubt, endoscopy

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14
Q

when is gastric cancer rare?

A

in patients under 45 years

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15
Q

what treatments would you give a patient if diagnosis for NUD is all negative?

A

Treat symptomatically

Usually with adequate dose of acid supression such as PPI

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16
Q

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

A

eradication therapy

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17
Q

what is nausea?

A

the sensation of feeling sick

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18
Q

what is retching?

A

Dry heaves (antrum contracts, glottis closed)

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19
Q

what is vomiting?

A

Abdominal contents expelled

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20
Q

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

A

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

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21
Q

What are some functional causes of nausea and vomiting?

A

Drugs

Pregnancy

Migraine

Cyclical vomiting syndrome

Alcohol

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22
Q

What is psychogenic vomiting?

A

Vomiting without any obvious organ pathology or with a psychological aetiology

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23
Q

Who often suffers from psychogenic vomiting?

A

young women

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24
Q

What often happens to psychogenic vomiting after admission?

A

it stops

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25
What is irritable bowel syndrome?
Condition of the digestive system that can cause crampls, bloating, diarrhoea and constipation
26
What is slow transit constipation?
Reduced motility of the large intestine caused by abnormalities of the enteric nerves
27
what are two types of functional disorders of the lower GI tract?
IBS Slow transit constipation
28
How does bowel habit from person to person vary?
There is a great variation in both bowel habit and stool weight
29
What is the average stool weight in the UK?
100-200g/day
30
What should be known about the interpretation of the word constipation?
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
31
What are alarm symptoms relating to constipation?
Age >50 Short symptoms history Unintentional weight loss Nocturnal symptoms Male sex Family history of bowel/ovarian cancer Anaemia Rectal bleeding Recent antibiotic use Abdominal mass
32
what is a good chart for use in description of bowel excretions?
bristol stool chart
33
What investigations should be done for slow transit constipation?
Colonoscopy FBC Blood glucose U + E Thyroid status Coeliac serology FIT testing Sigmoidoscopy
34
what physical examinations should be done for constipation?
Look for systemic disease Careful abdominal examination Rectal examination
35
What are different categories of the aetiology of constipation?
Systemic Neurogenic Organic Functional
36
What are examples of systemic causes of constipation?
Diabetes mellitus Hypothyroidism Hypercalcaemia
37
What are examples of neurogenic causes of constipation?
Autonomic neuropathies Parkinson's disease Strokes Multiple sclerosis Spina bifida
38
What are examples of organic causes of constipation?
Strictures Tumours Diverticular disease Proctitis Anal fissure
39
What are examples of functional causes of constipation?
Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients
40
What are clinical features of irritable bowel syndrome?
Abdominal pain Altered bowel habit Abdominal bloating Belching wind and flatus increased mucus production
41
What does IBS stand for?
Irritable bowel syndrome
42
What do NICE guidelines say is required to diagnose irritable bowel syndrome?
Rome 3 chart
43
What can be said about abdominal pain for IBS?
Very variable Vague Bloating Burning Sharp Occasionally radiates, often to lower back
44
What are different kinds of abdominal pain that can be felt with IBS?
Vague Bloating Burning Sharp
45
Does abdominal pain due to IBS ever radiate?
occasionally radiates often to back Pain can be replicated by balloon inflation suggesting it may be due to bowel distension Often altered by bowel action (improved) Rarely occurs at night
46
What are some examples of altered bowel habit for IBS?
Constipation (IBS-C) Diarrhoea (IBS-D) Both diarrhoea and constipation (IBS-M) Variability Urgency
47
What symptoms often coincide with bloating?
Wind and flatulence Relaxation abdominal wall muscles Mucus in stool Upper and other gastrointestinal symptoms
48
Wind and flatulence Relaxation abdominal wall muscles Mucus in stool Upper and other gastrointestinal symptoms
A compatible history Normal physical examination
49
What investigations are done for IBS?
Blood analysis FBC U & E, LFTs, Ca CRP TFTs Coeliac serology Stool Culture Calprotectin FIT testing Rectal Examination ?Colonoscopy
50
What causes calprotectin to be released?
inflamed gut mucosa
51
What is calprotectin used to differentiate?
Used for differentiating IBS from IBD and for monitoring IBD
52
What is the treatment for IBS?
A firm diagnosis Education and reassurance Dietetic review Tea, coffee, alcohol, sweetener Lactose, gluten exclusion trial FODMAP
53
What is discussed in a dietetic review for IBS?
Tea, coffee, alcohol, sweetener Lactose, gluten exclusion trial FODMAP
54
What is the FODMAPS diet?
(Fermentable Oligo-, Di- and Mono-Saccharides and Polyols)
55
What drug therapy is given for pain due to IBS?
antispasmodics linaclotide antidepressants TCAs SSRIs
56
What drug therapy is given for bloating due to IBS?
some probiotics linaclotide avoid - bulking agents (fibre) insufficient evidence antiflatuents
57
What drug therapy is given for constipaition due to IBS?
laxatives bulking agents / fibre softeners stimulants osmotic linaclotide avoid - TCAs, FODMAP not licenced 5HT4 agonists
58
What drug therapy is given for diarrhoea due to IBS?
anti motility agents FODMAP avoid SSRIs insufficient evidence Rifaximin
59
What psychological interventions can be done for IBS?
relaxation training Hypnotherapy
60
What patients should get relaxation training for IBS?
diarrhoea psychological comorbidity
61
What is the mode of action of relaxation training?
uses progressive muscle relaxation, biofeedback and meditation for stress
62
What is the mode of action for hypotherapy?
induces a state of deep relaxation
63
What patients with ISB should receive hypnosis?
pain constipation flatulance anxiety
64
What is flatulence?
passing gas from the digestive system out of the back passage
65
What is the mode of action of cognitive behavioural therapy?
involves identifying symptom triggers and learning to respond more appropriately
66
What patients with IBS is cognitive behaviour therapy useful for?
abdominal pain, bloating, flatulance
67
What patients with IBS is cognitive behaviour therapy not effective for?
depression when patient believe there is a physical cause for their symptoms
68
What is the mode of action of psychodynamic interpersonal therapy?
helps the patient to understand how emotions and bowel symptoms interrelate
69
What patients with IBS is psychodynamic interpersonal therapy useful for?
history of abuse
70
What patients with IBS is psychodynamic interpersonal therapy not useful for?
constipation constant pain depression
71
What causes IBS?
Altered Motility Visceral Hypersensitivity Stress, Anxiety, Depression
72
In simple terms, what is the bowel?
is a muscular tube that squeezes content from one end to the other
73
In what form of IBS are muscular contractions of the bowel stronger, and what form are they weaker?
In IBS-D, muscular contractions may be stronger and more frequent than normal. In IBS-C, contractions may be reduced
74
What is an example of gut response triggers being altered in IBS?
Contractions can be triggered by waking and eating In IBS-D, the response to these normal triggers may be stronger than normal. In IBS-C, the response may be reduced
75
what is the awareness of someones gut who has IBS like?
The brain is able to hear messages from the gut such as hunger or the urge to go to the toilet In IBS the brain hears these messages too loudly The gut works all day, every day, but most people do not feel it People with IBS often have an excessive awareness of normal digestive processes
76
How is the sensitivity of the gut due to stress in IBS different from normal?
We all get butterflies and diarrhoea in response to stress In IBS, the gut is more sensitive to stress, and this response can become chroni
77
What can be said about mortality and qualitiy of life of functional GI problems?

Alimentary System (44 decks)

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