Functional GI disorders Flashcards
What are the 2 broad categories of GI disease?
Structural
Functional
What is the difference between structural and functional GI disease?
Structural has detectable pathology whereas functional does not
what are the different types of structural detectable pathologies?
Macroscopic e.g. a Cancer
Microscopic e.g. Colitis
Usually Both
Prognosis depends on pathology
what are functions GI disorders related to?
gut function
how is the prognosis for a functional GI disorder?
Long-term prognosis good
What are examples of functional GI disorders?
Oesophageal spasm
Non-ulcer dyspepsia (NUD)
Biliary dyskinesia
Irritable bowel syndrome
Slow transit constipation
Drug related effects
What does NUD stand for?
Non-ulcer dyspepsia
What do functional GI disorders have a large impact on?
Quality of life
Psychological factors
What are functional GI disorders not associated with that structural disorders are?
Serious pathology
What is non-ulcer dyspepsia?
Chronic or recurrent abdominal pain or nausea, without an ulcer
What is the helicobacter pylori status of non-ulcer dyspepsia?
It varies
What diseases in non-ulcer dyspepsia probably a combination of?
Reflux
Low grade duodenal ulceration
Delayed gastric emptying
Irritable bowel syndrome
What does the diagnosis of non-ulcer dyspepsia involve?
Careful history and examination - FH is important
H Pylori status
Alarm symptoms
If in doubt, endoscopy
when is gastric cancer rare?
in patients under 45 years
what treatments would you give a patient if diagnosis for NUD is all negative?
Treat symptomatically
Usually with adequate dose of acid supression such as PPI
What therapy is required for non-ulcer dyspepsia when H Pylori is positive?
eradication therapy
what is nausea?
the sensation of feeling sick
what is retching?
Dry heaves (antrum contracts, glottis closed)
what is vomiting?
Abdominal contents expelled
What is often found in the history of nausea and vomiting immediately, 1 hour or more, 12 hours?
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
What are some functional causes of nausea and vomiting?
Drugs
Pregnancy
Migraine
Cyclical vomiting syndrome
Alcohol
What is psychogenic vomiting?
Vomiting without any obvious organ pathology or with a psychological aetiology
Who often suffers from psychogenic vomiting?
young women
What often happens to psychogenic vomiting after admission?
it stops
What is irritable bowel syndrome?
Condition of the digestive system that can cause crampls, bloating, diarrhoea and constipation
What is slow transit constipation?
Reduced motility of the large intestine caused by abnormalities of the enteric nerves
what are two types of functional disorders of the lower GI tract?
IBS
Slow transit constipation
How does bowel habit from person to person vary?
There is a great variation in both bowel habit and stool weight
What is the average stool weight in the UK?
100-200g/day
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
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
what is a good chart for use in description of bowel excretions?
bristol stool chart
What investigations should be done for slow transit constipation?
Colonoscopy
FBC
Blood glucose
U + E
Thyroid status
Coeliac serology
FIT testing
Sigmoidoscopy
what physical examinations should be done for constipation?
Look for systemic disease
Careful abdominal examination
Rectal examination
What are different categories of the aetiology of constipation?
Systemic
Neurogenic
Organic
Functional
What are examples of systemic causes of constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are examples of neurogenic causes of constipation?
Autonomic neuropathies
Parkinson’s disease
Strokes
Multiple sclerosis
Spina bifida
What are examples of organic causes of constipation?
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure
What are examples of functional causes of constipation?
Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients
What are clinical features of irritable bowel syndrome?
Abdominal pain
Altered bowel habit
Abdominal bloating
Belching wind and flatus
increased mucus production
What does IBS stand for?
Irritable bowel syndrome
What do NICE guidelines say is required to diagnose irritable bowel syndrome?
Rome 3 chart
What can be said about abdominal pain for IBS?
Very variable
Vague
Bloating
Burning
Sharp
Occasionally radiates, often to lower back
What are different kinds of abdominal pain that can be felt with IBS?
Vague
Bloating
Burning
Sharp
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
What are some examples of altered bowel habit for IBS?
Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability
Urgency
What symptoms often coincide with bloating?
Wind and flatulence
Relaxation abdominal wall muscles
Mucus in stool
Upper and other gastrointestinal symptoms
Wind and flatulence
Relaxation abdominal wall muscles
Mucus in stool
Upper and other gastrointestinal symptoms
A compatible history
Normal physical examination
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
What causes calprotectin to be released?
inflamed gut mucosa
What is calprotectin used to differentiate?
Used for differentiating IBS from IBD and for monitoring IBD
What is the treatment for IBS?
A firm diagnosis
Education and reassurance
Dietetic review
Tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP
What is discussed in a dietetic review for IBS?
Tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP
What is the FODMAPS diet?
(Fermentable Oligo-, Di- and Mono-Saccharides and Polyols)
What drug therapy is given for pain due to IBS?
antispasmodics
linaclotide
antidepressants
TCAs
SSRIs
What drug therapy is given for bloating due to IBS?
some probiotics
linaclotide
avoid - bulking agents (fibre)
insufficient evidence
antiflatuents
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
What drug therapy is given for diarrhoea due to IBS?
anti motility agents
FODMAP
avoid
SSRIs
insufficient evidence
Rifaximin
What psychological interventions can be done for IBS?
relaxation training
Hypnotherapy
What patients should get relaxation training for IBS?
diarrhoea
psychological comorbidity
What is the mode of action of relaxation training?
uses progressive muscle relaxation, biofeedback and meditation for stress
What is the mode of action for hypotherapy?
induces a state of deep relaxation
What patients with ISB should receive hypnosis?
pain
constipation
flatulance
anxiety
What is flatulence?
passing gas from the digestive system out of the back passage
What is the mode of action of cognitive behavioural therapy?
involves identifying symptom triggers and learning to respond more appropriately
What patients with IBS is cognitive behaviour therapy useful for?
abdominal pain, bloating, flatulance
What patients with IBS is cognitive behaviour therapy not effective for?
depression
when patient believe there is a physical cause for their symptoms
What is the mode of action of psychodynamic interpersonal therapy?
helps the patient to understand how emotions and bowel symptoms interrelate
What patients with IBS is psychodynamic interpersonal therapy useful for?
history of abuse
What patients with IBS is psychodynamic interpersonal therapy not useful for?
constipation
constant pain
depression
What causes IBS?
Altered Motility
Visceral Hypersensitivity
Stress, Anxiety, Depression
In simple terms, what is the bowel?
is a muscular tube that squeezes content from one end to the other
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
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
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
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
What can be said about mortality and qualitiy of life of functional GI problems?
