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GI -S > Functional GI Disorders > Flashcards

Functional GI Disorders Flashcards

1
Q

What are the two broad categories of GI disease?

A

Structural and Functional

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2
Q

What is structural GI disease?

A 
Detectable pathology
-Macroscopic (e.g cancer)
-Microscopic (e.g. Colitis)
Usually both
Prognosis depends on pathology
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3
Q

What is functional GI disease?

A

No detectable pathology
Related to gut function
“Software faults”
Long-term prognosis good

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4
Q

List some functional GI disorders

A 
Oesophagel spasm
Non-Ulcer Dysplasia (NUD)
Biliary Dyskinesia
Irritable Bowel Syndrome
Slow Transit Constipation
Drug Related Effects
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5
Q

What is Non-Ulcer Dyspepsia?

A 
Dyspeptic type pain
No Ulcer on endoscopy
Probably not a single disease
-Reflux
-Low grade duodenal ulceration
-Delayed Gastric emptying
-Irritable bowel syndrome
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6
Q

How do you diagnose Non-Ulcer Dyspepsia?

A

Careful history and examination

Gastric cancer? (rare in under 45s)

H. Pylori status? ->eradication

Alarm symptoms? (unexplained weightloss, vomiting)

If doubt: endoscopy

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7
Q

What is nausea?

A

Sensation of feeling sick

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8
Q

What is retching?

A

Dry heaves

Antrum contracts but glottis closed

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9
Q

What is Vomiting?

A

GI tract contents expelled

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10
Q

What are the sympathetic and Vagal components of vomiting?

A

Vomiting centre (may not exist as entity)

Chemoreceptor trigger zone

  • Receptors for opiates
  • Digoxin
  • Chemotherapy
  • Uraemia
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11
Q

How do you take a history of vomiting?

A 
LENGTH OF TIME AFTER FOOD:
-Immediate (psychogenic)
-One hour or more 
(pyloric obstruction, motility disorders such as diabetes or post gastrectomy)
-12 Hours (obstruction etc)
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12
Q

What are the functional causes of vomiting?

A 
Drugs
Pregnancy
Migraine
Cyclical Vomiting Syndrome
Alcohol
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13
Q

What is cyclical vomiting syndrome?

A

Onset often in childhood
Recurrent episodes of heavy vomiting
2-3 times a year up to times a month

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14
Q

What is psychogenic vomiting?

A

Vomits as soon as they are sick

Often young woman
Often for years
may have no preceding nausea
May be self induced (overlap with bulimia)
Appetite usually not disturbed but may lose weight
Often stops soon after admission

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15
Q

what are two common functional diseases of the lower GI tract?

A

Irritable bowel syndrome

Slow transit constipation

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16
Q

What is important to bare in mind about bowel habit?

A

Great variation.

Ask the patient: 
What is normal? 
What has changed?
-Frequency
-Consistency
-Blood
-Mucous
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17
Q

Disease of the lower GI tract should include what in its examination?

A

Look for systemic disease
Careful abdominal examination
Rectal exam if needed
FOB

18
Q

What are the investigations for change in bowel habit with constipation?

A 
FBC
Blood glucose
U+E
Thyroid status
Coeliac serology
Proctoscopy
Sigmoidoscopy
COLONOSCOPY
19
Q

What is the different approach you should take to fresh blood and dark red blood in the stool?

A

Fresh blood is common. Take in context

Dark blood is usually worth investigating

20
Q

What is the aetiology of constipation?

A

Systemic
Neurogenic
Organic
Functional

21
Q

What are some of the organic aetiologies of of constipation?

A 
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissue
22
Q

What are some of the functional aetiologies of constipation?

A 
Megacolon
Ideopathic constipation
Depression
Psychosis
Institutionalised patients
23
Q

What are some of the systemic causes of constipation?

A

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

24
Q

What are some of the Neurogenic causes of constipation?

A 
Autonomic Neuropathies
Parkinson's disease
Strokes
Multiple sclerosis
Spina bifida
25
Q

what are the clinical features of IBS?

A

Abdominal pain
Altered Bowel habit
Abdominal bloating

Belching wind and flatus
Mucous

26
Q

What is the Rome criteria for IBS?

A

Abdominal pain:

  • Relieved by defaeation
  • Associated with change of frequency
  • Associated change of consistency

AND (2 or more)

  • Altered stool frequency
  • Altered stool form
  • Altered stool passage
  • Passgae of mucous
  • Bloating
27
Q

What is the abdominal pain in IBS like?

A

Vary variable

  • Vague
  • Bloating
  • Burning
  • Sharp

Occasionally radiated often to lower back
(So does IBD…)

28
Q

what do we mean with altered bowel habit in IBS?

A 
Constipation (IBS-C)
Diarrhoea (IBS-D)
Both diarrhoea and constipation (IBS-M)
Variability
Urgency
29
Q

What is the bloating in IBS like?

A 
Often very prominent
Wind and flatulence
Relaxation of abdominal muscles
Mucous in stool
Upper and other GI symptoms
30
Q

What two things are requires of a diagnosis of IBS?

A

A compatible history

Normal physical examination

31
Q

What are the investigations for IBS?

A

Blood analysis

  • FBC
  • U+E, LFT, Ca
  • CRP
  • TFTs (thyroid function tests)
  • Coeliac serology

Stool Culture

Calprotectin

32
Q

How should CRP differentiate between IBS and IBD?

A

CRP should be normal in IBS and raised in IBD

33
Q

What is calprotectin?

A

Protein released by inflamed mucosa
Detected in stool
Used for DIFFERENTIATING IBS from IBD

Used for monitoring in IBD

34
Q

What dietetic review can be carried out in IBS patients?

A

Tea, coffee, alcohol, sweetener (laxatives)

Lactose, gluten exclusion trial

FODMAP

35
Q

What is FODMAP

A

Exclusion diet to work out if any of the items involved cause symptoms

36
Q

What is the drug therapy for pain in IBS?

A

Pain

  • Linaclotide (IBS-C)
  • Antidepressents
    • TCAs (IBS-D)
    • SSRIs (IBS-C)
37
Q

What is the treatment for bloating in IBS?

A

Some probiotics
Linaclotide (IBS-C)

Avoid
-Bulking agents/ fibre

38
Q

What is the treatment for constipation in IBS?

A 
Laxatives
-Bulking agents/fibre (episodic)
-Softeners (adjuvant)
-Stimulants (occasionally)
-Osmotics (regular)
Linoclotide

Avoid

  • TCAs
  • FODMAP
39
Q

What is the drug therapy for diarrhoea in IBS?

A

Anti motility agents
FODMAP

Avoid SSRIs

40
Q

How do the contractions of the bowel differ in IBS-C and IBS-D?

A

IBS-D contractions may be stronger and more frequent

In IBS-C contractions may be reduced

41
Q

What 3 things cause IBS?

A

Altered motility
Visceral hypersensitivity
Stress, anxiety, depression

42
Q

What do we mean by heightened gut awareness in IBS?

A

People with IBS often have an excessive awareness of normal digestive processes

GI -S (29 decks)

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