Functional GI Disorders Flashcards
What are the two main categories of GI disease?
Structural
Functional
What differentiates functional vs structural GI pathologies?
Functional diseases not detectable, relate to gut function
How does non-ulcer dyspepsia present?
Dyspeptic pain Reflux Low grade duodenal ulceration Delayed gastric emptying IBS NO ULCER ENDOSCOPY
What is the H. pylori status in non-ulcer dyspepsia?
Varied, not necessarily negative
What must you be cautious of in dyspepsia patients?
Alarm symptoms
What are the alarm symptoms of dyspepsia?
Weight Loss Fe-deficiency anaemia GI bleeding Persistent vomiting Difficulty Swallowing Epigastric mass
What detail needs to be asked to a patient presenting with vomiting after eating?
The length of time after food
Vomiting immediately after eating is suggestive of what?
Psychogenic cause
Vomiting 1hr+ after eating is suggestive of what?
Pyloric obstruction
Motility disorders
Vomiting 12hrs+ after eating is suggestive of what?
Obstruction
What are the functional causes of vomiting?
Drugs + Alcohol Pregnancy Migraine Cyclical Cyclical Vomiting Syndrome
How does Cyclical Vomiting Syndrome present?
Childhood onset
2-3 x year, 2-3 months
How does psychogenic vomiting present?
Young women
No preceding nausea
May be self induced
Often stops after admission
A negative FIT test suggests what?
Low likelihood of organic pathology
What tests should be performed on a patient presenting with motility changes and alarm symptoms?
FBC, U+E Glucose Thyroid function Coeliac serology FIT testing Sigmoidoscopy
What are the organic causes of constipation?
Strictures Tumours Diverticular disease Proctitis Anal fissure
What are the functional causes of constipation?
Megacolon
Idiopathic
Depression
Psychosis
What are the systemic causes of constipation?
Diabetes mellitus
Hypothyroidism
Hypercalcaemia
What are the neurogenic causes of constipation?
Parkinson’s
Strokes
MS
Spina bifida
Symptoms of IBS
Nervous colon (unhelpful)
Clinical features of IBS
Abdominal pain Altered bowel habit Bloating Flatus Mucus
What is IBS-C/D/M?
IBS altered bowel habit
C - constipation
D - diarrhoea
M - both (mixed)
What investigations are made for an IBS patient?
Blood analysis
Stool culture
Calprotectin
FIT testing
When is calprotectin released?
When gut mucosa is inflamed
What is testing calprotectin levels used for?
Differentiating IBS from IBD
Monitoring IBD
How is IBS diagnosed?
Compatible history
Normal physical examination
How is IBS treated?
Definitive diagnosis Education and reassurance Dietetic review ?FODMAP ?drug therapy ?psychological intervention
What is the mechanism behind IBS?
Increased/decreased gut response to stimuli
Brain “hearing” the gut too loudly
