Functional GI disorders

Question 1

non-ulcer dyspepsia is probably a collection of a few conditions. What are these?

Answer 1

reflux
low grade duodenal ulceration
delayed gastric emptying
irritable bowel syndrome

Question 2

how is non-ulcer dyspepsia diagnosed?

Answer 2

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

Question 3

what is retching?

Answer 3

dry heaves

the antrum contracts but the glottis stays shut

Question 4

what are the sympathetic and vagal components of vomiting?

Answer 4

vomiting center

chemoreceptor trigger zone

Question 5

what are triggers at the chemoreceptor trigger zone for vomiting?

Answer 5

opiates
chemotherapy
digoxin
uraemia

Question 6

when someone has contact vomiting, what do you need to enquire about in the history?

Answer 6

when the vomiting starts after food;
immediate
1 hour or more
12 hours later

Question 7

what is the most likely cause if vomitting occurs 1 hour or later after eating?

Answer 7

pyloric obstruction

motility disorders i.e. diabetes post gastrectomy

Question 8

what is the most likely cause for vomiting if it occurs over 12 hours after eating?

Answer 8

obstruction

Question 9

what is psychogenic vomiting and what does it involve?

Answer 9

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

Question 10

what are functional causes of nausea?

Answer 10

drugs
alcohol
pregnancy
migraine
clinical vomiting syndrome

Question 11

what is the gold standard investigation for bowel disorders?

Answer 11

colonoscopy

Question 12

what are alarming symptoms for bowel disorders?

Answer 12

> 50 yrs old
short symptom history
nocturnal symptoms
anaemia
male sex
family history of bowel/ovarian cancer
rectal bleeding
recent antibiotic use
abdominal mass

Question 13

what are the systemic causes of constipation?

Answer 13

diabetes
hypothyroidism
hypercalcaemia

Question 14

what are the neurogenic causes of constipation?

Answer 14

autonomic neuropathies
parkinsons disease
stroke
multiple sclerosis
spina bifida

Question 15

what are the organic causes of constipation?

Answer 15

strictures
tumours
diverticular disease
proctitis 
anal tissue

Question 16

what are the functional causes of constipation?

Answer 16

megacolon
idiopathic constipation
depression
institutionalised patients

Question 17

what causes IBS?

Answer 17

altered motility
visceral hypersensitivity
stress, anxiety, depression

Question 18

what is the NICE guidelines for diagnosis of IBS?

Answer 18

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

Question 19

what is the ROME III diagnostic criteria for diagnosing IBS?

Answer 19

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

Question 20

what are the clinical features of IBS?

Answer 20

abdominal pain (colicky pain)
abdominal bloating
altered bowel habit 
belching wind and flatus
mucous

Question 21

what investigations are carried out to diagnose IBS?

Answer 21

FBC, U&E's
CRP
thyroid función test
coealiac test
calprotectin 
stool culture
Faecal Immunological test FIT
rectal examination 
colonoscopy

Question 22

what are some of the treatments for IBS?

Answer 22

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

Question 23

what are the different types of pain associated with IBS?

Answer 23

vague 
bloating
burning
sharp 
occasionally radiates to the back

Question 24

what is pain in IBS caused by?

Answer 24

bowel distension

Question 25

what is characteristic of the altered bowel habits in IBS?

Answer 25

constipation
diarrhoea
or both
urgency
variability

Question 26

linaclotide is a useful drug for what type of IBS?

Answer 26

IBS-C

Question 27

What are the terms for a functional bowl obstruction?

Answer 27

Acute - paralytic lieus

Chronic - pseudo obstruction

Question 28

What are the causes of a paralytic lieu’s?

Answer 28

Severe electrolyte imbalance
Low K levels
Abdominal or pelvic surgery
Infections I.e. gastroenteritis or appendicitis
Drugs i.e. opioids, antidepressants, anti muscarinics

Question 29

What are the causes of a pseudo obstruction?

Answer 29

Parkinson’s disease
Other neuromuscular disorders
Conditions which cause neuropathy i.e. diabetes

Question 30

What are the complications from a functional intestinal obstruction?

Answer 30

Ischemia

Dehydration

Question 31

What is the treatment for a functional intestinal obstruction?

Answer 31

Conservative - surgery is reserved for severely ill patients I.e. ischemia

Fluids
Bowel rest
Nasogastric suction

Question 32

What are the symptoms/signs of an functional bowel obstruction

Answer 32

Abdominal pain 
Cramps 
Bloating 
Inability to release gas
Foul breath 
Constipation 
Nausea and vomiting