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Alimentary System > Functional GI disorders > Flashcards

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
Q

What is irritable bowel syndrome?

A

Condition of the digestive system that can cause crampls, bloating, diarrhoea and constipation

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26
Q

What is slow transit constipation?

A

Reduced motility of the large intestine caused by abnormalities of the enteric nerves

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27
Q

what are two types of functional disorders of the lower GI tract?

A

IBS
Slow transit constipation

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28
Q

How does bowel habit from person to person vary?

A

There is a great variation in both bowel habit and stool weight

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29
Q

What is the average stool weight in the UK?

A

100-200g/day

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30
Q

What should be known about the interpretation of the word constipation?

A

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

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31
Q

What are alarm symptoms relating to constipation?

A

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
Q

what is a good chart for use in description of bowel excretions?

A

bristol stool chart

33
Q

What investigations should be done for slow transit constipation?

A

Colonoscopy

FBC

Blood glucose

U + E

Thyroid status

Coeliac serology

FIT testing

Sigmoidoscopy

34
Q

what physical examinations should be done for constipation?

A

Look for systemic disease
Careful abdominal examination
Rectal examination

35
Q

What are different categories of the aetiology of constipation?

A

Systemic

Neurogenic

Organic

Functional

36
Q

What are examples of systemic causes of constipation?

A

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

37
Q

What are examples of neurogenic causes of constipation?

A

Autonomic neuropathies
Parkinson’s disease
Strokes
Multiple sclerosis
Spina bifida

38
Q

What are examples of organic causes of constipation?

A

Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure

39
Q

What are examples of functional causes of constipation?

A

Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients

40
Q

What are clinical features of irritable bowel syndrome?

A

Abdominal pain
Altered bowel habit
Abdominal bloating
Belching wind and flatus
increased mucus production

41
Q

What does IBS stand for?

A

Irritable bowel syndrome

42
Q

What do NICE guidelines say is required to diagnose irritable bowel syndrome?

A

Rome 3 chart

43
Q

What can be said about abdominal pain for IBS?

A

Very variable
Vague
Bloating
Burning
Sharp
Occasionally radiates, often to lower back

44
Q

What are different kinds of abdominal pain that can be felt with IBS?

A

Vague
Bloating
Burning
Sharp

45
Q

Does abdominal pain due to IBS ever radiate?

A

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
Q

What are some examples of altered bowel habit for IBS?

A

Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability
Urgency

47
Q

What symptoms often coincide with bloating?

A

Wind and flatulence
Relaxation abdominal wall muscles
Mucus in stool
Upper and other gastrointestinal symptoms

48
Q

Wind and flatulence
Relaxation abdominal wall muscles
Mucus in stool
Upper and other gastrointestinal symptoms

A

A compatible history
Normal physical examination

49
Q

What investigations are done for IBS?

A

Blood analysis
FBC
U & E, LFTs, Ca
CRP
TFTs
Coeliac serology

Stool Culture

Calprotectin

FIT testing

Rectal Examination

?Colonoscopy

50
Q

What causes calprotectin to be released?

A

inflamed gut mucosa

51
Q

What is calprotectin used to differentiate?

A

Used for differentiating IBS from IBD and for monitoring IBD

52
Q

What is the treatment for IBS?

A

A firm diagnosis

Education and reassurance

Dietetic review
Tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP

53
Q

What is discussed in a dietetic review for IBS?

A

Tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP

54
Q

What is the FODMAPS diet?

A

(Fermentable Oligo-, Di- and Mono-Saccharides and Polyols)

55
Q

What drug therapy is given for pain due to IBS?

A

antispasmodics
linaclotide
antidepressants
TCAs
SSRIs

56
Q

What drug therapy is given for bloating due to IBS?

A

some probiotics
linaclotide

avoid - bulking agents (fibre)

insufficient evidence
antiflatuents

57
Q

What drug therapy is given for constipaition due to IBS?

A

laxatives
bulking agents / fibre
softeners
stimulants
osmotic
linaclotide

avoid - TCAs, FODMAP

not licenced
5HT4 agonists

58
Q

What drug therapy is given for diarrhoea due to IBS?

A

anti motility agents
FODMAP

avoid
SSRIs

insufficient evidence
Rifaximin

59
Q

What psychological interventions can be done for IBS?

A

relaxation training
Hypnotherapy

60
Q

What patients should get relaxation training for IBS?

A

diarrhoea
psychological comorbidity

61
Q

What is the mode of action of relaxation training?

A

uses progressive muscle relaxation, biofeedback and meditation for stress

62
Q

What is the mode of action for hypotherapy?

A

induces a state of deep relaxation

63
Q

What patients with ISB should receive hypnosis?

A

pain
constipation
flatulance
anxiety

64
Q

What is flatulence?

A

passing gas from the digestive system out of the back passage

65
Q

What is the mode of action of cognitive behavioural therapy?

A

involves identifying symptom triggers and learning to respond more appropriately

66
Q

What patients with IBS is cognitive behaviour therapy useful for?

A

abdominal pain, bloating, flatulance

67
Q

What patients with IBS is cognitive behaviour therapy not effective for?

A

depression
when patient believe there is a physical cause for their symptoms

68
Q

What is the mode of action of psychodynamic interpersonal therapy?

A

helps the patient to understand how emotions and bowel symptoms interrelate

69
Q

What patients with IBS is psychodynamic interpersonal therapy useful for?

A

history of abuse

70
Q

What patients with IBS is psychodynamic interpersonal therapy not useful for?

A

constipation
constant pain
depression

71
Q

What causes IBS?

A

Altered Motility

Visceral Hypersensitivity

Stress, Anxiety, Depression

72
Q

In simple terms, what is the bowel?

A

is a muscular tube that squeezes content from one end to the other

73
Q

In what form of IBS are muscular contractions of the bowel stronger, and what form are they weaker?

A

In IBS-D, muscular contractions may be stronger and more frequent than normal. In IBS-C, contractions may be reduced

74
Q

What is an example of gut response triggers being altered in IBS?

A

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
Q

what is the awareness of someones gut who has IBS like?

A

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
Q

How is the sensitivity of the gut due to stress in IBS different from normal?

A

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
Q

What can be said about mortality and qualitiy of life of functional GI problems?

A

Alimentary System (44 decks)

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