functional GI disorders

Question 1

what is functional GI?

Answer 1

Common, unexplained disorders. Examples :-–Irritable Bowel Syndrome –Functional Dyspepsia –Functional Constipation (most cases) •Chronic abdominal symptoms in the absence of biochemical or structural explanation •Abdominal pain, bloating, nausea, erratic bowel habit, early satiety etc…..

Question 2

rome 3 classification?

Answer 2

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Question 3

rome 3 ibd criteria?

Answer 3

Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months that has two or more of the following features: –Improved with defæcation –Onset associated with a change in frequency –Onset associated with a change in form

Question 4

abcd of ibs?

Answer 4

Abdominal Pain •Bloating •Constipation •Diarrhoea

Question 5

rome 3 criteria of functional dyspepsia?

Answer 5

One or more of: –Bothersome postprandial fullness –Early satiation –Epigastric pain –Epigastric burning AND •No evidence of organic disease (including at upper endoscopy) that is likely to explain the symptoms

Question 6

ibs extra intestinal symptoms?

Answer 6

tiredness, back pain, bad breath

Question 7

list of medically unexplained symptoms?

Answer 7

Irritable Bowel Syndrome •Fibromyalgia •Chronic fatigue Syndrome •Irritable Bladder Syndrome •Tinnitus •Non-inflammatory pelvic pain etc.

Question 8

proposed mechanism?

Answer 8

Altered intestinal motility – ‘spasm’ •Visceral hypersensitivity (normal & abnormal GI events) •Altered CNS perception of visceral events •Psychological factors •Previous intestinal infection

Question 9

psychological factors?

Answer 9

Stress influences GI function/symptoms •Psychological disorders can give GI complaints •Stress may trigger & exacerbate IBS symptoms - increased prevalence anxiety/ depression •No specific profile of personality that is unique to IBS

Question 10

differential diagnosis?

Answer 10

Cancer – (Gastric/Oesophageal Pancreatic/Gynae. etc) •Peptic ulcers •G-O reflux •Cardiac / pleuritic pain •Gallstones •Pancreatitis •Coeliac disease •Lactose intolerance •Infection •Ulcerative colitis •Crohn’s Disease •Intestinal ischaemia •Diverticulosis •Endometriosis •Thyroid disease •Hypo/hyper calcaemia •Drugs •Psychiatric disorders

Question 11

investigations?

Answer 11

Can diagnose FGID’s with established criteria & limited exclusion of organic (structural, metabolic, infectious) diseases •Detailed assessment of symptoms •Physical examination – (can have bloating/tenderness) •Further tests – blood / stool (C&S, Calprotectin), endoscopy, radiology

Question 12

symptoms of organic disease?

Answer 12

New onset older age •Pain that interferes with normal sleep •Diarrhoea during night / Steatorrhoea •Visible / occult blood in the stool •Weight loss •Fever

Question 13

lab features?

Answer 13

Elevated ESR / CRP •Anaemia / ↑ WBC or Platelets •Hypokalaemia / Hypoalbuminaemia •Blood, pus or fat in the stool •Stool weight >200g/day •Persistent diarrhoea during 48hr fast

Question 14

drug options?

Answer 14

Laxatives •Antidiarrhoeals •Antiemetics •Antispasmodics •Anticholinergics •Antidepressants Ispaghula husk Lactulose/ MgOH Loperamide Domperidone Peppermint oil Mebeverine Hyoscine Amitriptyline

Question 15

serotonin & the gi?

Answer 15

5 HT3 antagonists (eg Alensetron) inhibit motility – colonic transit time (excess water absorption) – intestinal secretion •5 HT4 agonists (eg Prucalopride) stimulate motility –  increase gastric emptying –  peristalsis –  colonic activity ( small bowel transit time)