Functional GI Disorders Flashcards
What are the two broad categories of GI disease?
Structural and Functional
What is structural GI disease?
Detectable pathology -Macroscopic (e.g cancer) -Microscopic (e.g. Colitis) Usually both Prognosis depends on pathology
What is functional GI disease?
No detectable pathology
Related to gut function
“Software faults”
Long-term prognosis good
List some functional GI disorders
Oesophagel spasm Non-Ulcer Dysplasia (NUD) Biliary Dyskinesia Irritable Bowel Syndrome Slow Transit Constipation Drug Related Effects
What is Non-Ulcer Dyspepsia?
Dyspeptic type pain No Ulcer on endoscopy Probably not a single disease -Reflux -Low grade duodenal ulceration -Delayed Gastric emptying -Irritable bowel syndrome
How do you diagnose Non-Ulcer Dyspepsia?
Careful history and examination
Gastric cancer? (rare in under 45s)
H. Pylori status? ->eradication
Alarm symptoms? (unexplained weightloss, vomiting)
If doubt: endoscopy
What is nausea?
Sensation of feeling sick
What is retching?
Dry heaves
Antrum contracts but glottis closed
What is Vomiting?
GI tract contents expelled
What are the sympathetic and Vagal components of vomiting?
Vomiting centre (may not exist as entity)
Chemoreceptor trigger zone
- Receptors for opiates
- Digoxin
- Chemotherapy
- Uraemia
How do you take a history of vomiting?
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)
What are the functional causes of vomiting?
Drugs Pregnancy Migraine Cyclical Vomiting Syndrome Alcohol
What is cyclical vomiting syndrome?
Onset often in childhood
Recurrent episodes of heavy vomiting
2-3 times a year up to times a month
What is psychogenic vomiting?
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
what are two common functional diseases of the lower GI tract?
Irritable bowel syndrome
Slow transit constipation
What is important to bare in mind about bowel habit?
Great variation.
Ask the patient: What is normal? What has changed? -Frequency -Consistency -Blood -Mucous
Disease of the lower GI tract should include what in its examination?
Look for systemic disease
Careful abdominal examination
Rectal exam if needed
FOB
What are the investigations for change in bowel habit with constipation?
FBC Blood glucose U+E Thyroid status Coeliac serology Proctoscopy Sigmoidoscopy COLONOSCOPY
What is the different approach you should take to fresh blood and dark red blood in the stool?
Fresh blood is common. Take in context
Dark blood is usually worth investigating
What is the aetiology of constipation?
Systemic
Neurogenic
Organic
Functional
What are some of the organic aetiologies of of constipation?
Strictures Tumours Diverticular disease Proctitis Anal fissue
What are some of the functional aetiologies of constipation?
Megacolon Ideopathic constipation Depression Psychosis Institutionalised patients
What are some of the systemic causes of constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are some of the Neurogenic causes of constipation?
Autonomic Neuropathies Parkinson's disease Strokes Multiple sclerosis Spina bifida
what are the clinical features of IBS?
Abdominal pain
Altered Bowel habit
Abdominal bloating
Belching wind and flatus
Mucous
What is the Rome criteria for IBS?
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
What is the abdominal pain in IBS like?
Vary variable
- Vague
- Bloating
- Burning
- Sharp
Occasionally radiated often to lower back
(So does IBD…)
what do we mean with altered bowel habit in IBS?
Constipation (IBS-C) Diarrhoea (IBS-D) Both diarrhoea and constipation (IBS-M) Variability Urgency
What is the bloating in IBS like?
Often very prominent Wind and flatulence Relaxation of abdominal muscles Mucous in stool Upper and other GI symptoms
What two things are requires of a diagnosis of IBS?
A compatible history
Normal physical examination
What are the investigations for IBS?
Blood analysis
- FBC
- U+E, LFT, Ca
- CRP
- TFTs (thyroid function tests)
- Coeliac serology
Stool Culture
Calprotectin
How should CRP differentiate between IBS and IBD?
CRP should be normal in IBS and raised in IBD
What is calprotectin?
Protein released by inflamed mucosa
Detected in stool
Used for DIFFERENTIATING IBS from IBD
Used for monitoring in IBD
What dietetic review can be carried out in IBS patients?
Tea, coffee, alcohol, sweetener (laxatives)
Lactose, gluten exclusion trial
FODMAP
What is FODMAP
Exclusion diet to work out if any of the items involved cause symptoms
What is the drug therapy for pain in IBS?
Pain
- Linaclotide (IBS-C)
- Antidepressents
- TCAs (IBS-D)
- SSRIs (IBS-C)
What is the treatment for bloating in IBS?
Some probiotics
Linaclotide (IBS-C)
Avoid
-Bulking agents/ fibre
What is the treatment for constipation in IBS?
Laxatives -Bulking agents/fibre (episodic) -Softeners (adjuvant) -Stimulants (occasionally) -Osmotics (regular) Linoclotide
Avoid
- TCAs
- FODMAP
What is the drug therapy for diarrhoea in IBS?
Anti motility agents
FODMAP
Avoid SSRIs
How do the contractions of the bowel differ in IBS-C and IBS-D?
IBS-D contractions may be stronger and more frequent
In IBS-C contractions may be reduced
What 3 things cause IBS?
Altered motility
Visceral hypersensitivity
Stress, anxiety, depression
What do we mean by heightened gut awareness in IBS?
People with IBS often have an excessive awareness of normal digestive processes
