Functional GI disorders Flashcards
What are the 2 types of GI disease?
Structural
Functional
What is a structural GI disease?
Detectable pathology, either macro or microscopic
What is an example of a macro and microscopic structural pathology?
Macro= cancer Micro= colitis
What is functional GI disease?
Structure is normal and there is no detectable pathology, but function is not working
What is non ulcer dyspepsia?
Dyspepsic type pain but no ulcer on endoscopy
Not a single disease, covers a range of things
What disorders does the term non ulcer dyspepsia cover?
Reflux
Low grade duodenal ulceration
Delayed gastric emptying
IBS
How is non ulcer dyspepsia diagnosed?
History and exam
If in doubt, endoscopy
How is non ulcer dyspepsia treated?
Symptomatically
Eradication of H pylori if necessary
How is vomiting controlled?
Vomiting centre
Chemoreceptor trigger zone
What can activate the chemoreceptor trigger zone of the vomiting centre?
Opiates
Digoxin
Chemotherapy
Iraemia
What does immediate vomiting after eating suggest?
Psychogenic disorder
What does vomiting 1 or more hours after eating suggest?
Pyloric obstruction
Motility disorders
What does vomiting 12 or more hours after eating suggest?
Obstruction of small intestine
What are the functional causes of vomiting?
Drugs Pregnancy Migraine Cyclical vomiting syndrome Alcohol
What is cyclical vomiting syndrome?
Recurrent episodes of severe vomiting for 2-3 days from several times a year to several times a month
What are some features of psychogenic vomiting?
Mainly young women
May have no preceding nausea or appetite change
May be self induced, may cause weight loss
Often stops soon after admission
What signs and symptoms would cause alarm when paired with a change in stool?
Age, anaemia, abode mass, antibiotic use Family history Loss of weight Male Nocturnal symptoms Rectal bleeding Short symptom history
What investigations are done in everyone who has had a change in stool?
FBC Blood glucose U+E Thyroid Coeliac serology
What are the 4 causes of constipation?
Systemic
Neurogenic
Organic
Functional
What are the systemic causes of constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are the neurogenic causes of constipation?
Autonomic neuropathies Parkinson's Stroke MS Spina bifida
What are the organic causes of constipation?
Strictures Tumours Diverticular disease Proctitis Anal fissure
What are the functional causes of constipation?
Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients
What are the clinical features of IBS?
Abdo pain
Altered bowel habit
Abdo bloating
What are the features of IBS pain?
Occasionally radiates, mainly to lower back
Often improved by bowel action
Rarely at night
What are the types of changes in bowel habit we look for in IBS?
Constipation Diarrhoea Both Variability Urgency
How is IBS diagnosed?
Compatible history
Normal physical examination
What investigations can be done for IBS?
Blood analysis Stool culture Calprotectin Possible rectal exam and FOB Colonoscopy if there are concerning features?
How is IBS treated?
Education and reassurance
Dietetic review
Drug therapy
Psychological intervention
What drugs can be used for pain in IBS?
Antispasmodics
IBS-C- linaclotide and SSRIs
IBS-D- TCA antidepressants
What drugs can be used for bloating in IBS?
Probiotics
IBS-C- linaclotide
What drugs can be used for constipation in IBS?
Laxatives
Linaclotides
What drugs can used for diarrhoea in IBS?
Antimotiloty agents
What psychological interventions can be used in IBS?
Relaxation therapy
Hypnotherapy
Cognitive behavioural therapy
Psychodynamic therapy
What is the cause of IBS?
Altered motility
Visceral hypersensitivity
Stress, anxiety, depression
What happens in IBSD?
Bowel contractions stronger and more frequent
Response to gut triggers stronger
What happens in IBSC?
Bowel contractions reduced
Response to gut triggers weaker
