Functional GI disorders Flashcards
non-ulcer dyspepsia is probably a collection of a few conditions. What are these?
reflux
low grade duodenal ulceration
delayed gastric emptying
irritable bowel syndrome
how is non-ulcer dyspepsia diagnosed?
history & examination
test for Hpylori, gastric cancer and enquire about ALARM symptoms
if all negative then diagnosis is +ve.
H.pylori status varies in non-ulcer dyspepsia
what is retching?
dry heaves
the antrum contracts but the glottis stays shut
what are the sympathetic and vagal components of vomiting?
vomiting center
chemoreceptor trigger zone
what are triggers at the chemoreceptor trigger zone for vomiting?
opiates
chemotherapy
digoxin
uraemia
when someone has contact vomiting, what do you need to enquire about in the history?
when the vomiting starts after food;
immediate
1 hour or more
12 hours later
what is the most likely cause if vomitting occurs 1 hour or later after eating?
pyloric obstruction
motility disorders i.e. diabetes post gastrectomy
what is the most likely cause for vomiting if it occurs over 12 hours after eating?
obstruction
what is psychogenic vomiting and what does it involve?
usually vomit immediately after eating
their appetite isn’t affected
shortly stops after admission
often in young women but have to distinguish if its self inflicted i.e. bulimia
what are functional causes of nausea?
drugs alcohol pregnancy migraine clinical vomiting syndrome
what is the gold standard investigation for bowel disorders?
colonoscopy
what are alarming symptoms for bowel disorders?
> 50 yrs old short symptom history nocturnal symptoms anaemia male sex family history of bowel/ovarian cancer rectal bleeding recent antibiotic use abdominal mass
what are the systemic causes of constipation?
diabetes
hypothyroidism
hypercalcaemia
what are the neurogenic causes of constipation?
autonomic neuropathies parkinsons disease stroke multiple sclerosis spina bifida
what are the organic causes of constipation?
strictures tumours diverticular disease proctitis anal tissue
what are the functional causes of constipation?
megacolon
idiopathic constipation
depression
institutionalised patients
what causes IBS?
altered motility
visceral hypersensitivity
stress, anxiety, depression
what is the NICE guidelines for diagnosis of IBS?
abdominal pain/discomfort relieved by defection or associated with altered stool frequency/form, plus 2 of the following;
- altered stool passage
- abdominal bloating/distension
- symptoms made worse by eating
- passage of mucous
what is the ROME III diagnostic criteria for diagnosing IBS?
recurrent abdominal pain/discomfort for >3days/month in the past 3 months associated with 2 or more of:
- improved with defaecation
- onset associated with change in stool frequency
- onset associated with change in stool form
what are the clinical features of IBS?
abdominal pain (colicky pain) abdominal bloating altered bowel habit belching wind and flatus mucous
what investigations are carried out to diagnose IBS?
FBC, U&E's CRP thyroid función test coealiac test calprotectin stool culture Faecal Immunological test FIT rectal examination colonoscopy
what are some of the treatments for IBS?
diet exclusion of certain foods.
pain - antispasmodics i.e. linaclotide
bloating - probiotics i.e. linaclotide
constipation - laxatives i.e. linaclotide and peppermint supplements
diarrhoea - antimotillity agens, FODMAP diet
psychological interventions i.e. CBT, hypnotherapy, relaxation training, psychodynamic interpersonal therapy
what are the different types of pain associated with IBS?
vague bloating burning sharp occasionally radiates to the back
what is pain in IBS caused by?
bowel distension
what is characteristic of the altered bowel habits in IBS?
constipation diarrhoea or both urgency variability
linaclotide is a useful drug for what type of IBS?
IBS-C
What are the terms for a functional bowl obstruction?
Acute - paralytic lieus
Chronic - pseudo obstruction
What are the causes of a paralytic lieu’s?
Severe electrolyte imbalance
Low K levels
Abdominal or pelvic surgery
Infections I.e. gastroenteritis or appendicitis
Drugs i.e. opioids, antidepressants, anti muscarinics
What are the causes of a pseudo obstruction?
Parkinson’s disease
Other neuromuscular disorders
Conditions which cause neuropathy i.e. diabetes
What are the complications from a functional intestinal obstruction?
Ischemia
Dehydration
What is the treatment for a functional intestinal obstruction?
Conservative - surgery is reserved for severely ill patients I.e. ischemia
Fluids
Bowel rest
Nasogastric suction
What are the symptoms/signs of an functional bowel obstruction
Abdominal pain Cramps Bloating Inability to release gas Foul breath Constipation Nausea and vomiting
