Functional Gut Disorders

Question 1

What is the main PP beyond coeliac disease? (CoD)

Answer 1

a) Gliadin is immunogenic
b) Direct toxic effects through upregulating innate immune system or HLADQ2 presents it to T helper cells in lamina propria
c) Inflammation –> Villi atrophy –> Malabsorption

Question 2

What are the main symptoms of coeliac disease?

Answer 2

1) Diarrhoea
2) Weight Loss
3) Irritable bowel
4) Iron deficiency
5) Abnormal liver function
6) Mouth ulcers

Question 3

What investigations would you conduct for someone with coeliac disease?

Answer 3

1) Serology: Look for autoantibodies tTG and EMA

2) Gastroscopy: Duodenal biopsies

Question 4

What is the site and distribution of Crohn’s disease?

Answer 4

Anywhere from mouth to anus

Patchy distribution

Question 5

What are the complications of Crohn’s disease?

Answer 5

Malabsorption, Fistula, Obstruction, Perforation, Neoplasia, Anal fissures, Amyloidosis [Rare]

Question 6

What is the site and distribution of Ulcerative Colitis?

Answer 6

Starts at the rectum, proximally spreading. Will only affect the colon and in a continual distribution

Question 7

What are the main complications of UC?

Answer 7

1) Loss of blood in colon and Colorectal cancer risk
2) Arthritis
3) Iritis and Episcleritis
4) Erythema Nodosum
5) Fatty liver and primary sclerosing cholangitis

Question 8

What is a main example of a functional bowel disorder (and cause)?

Answer 8

IBS - No known main cause

Question 9

What the M-F PP of IBS

Answer 9

Genetics, Psychological Morbidity, abnormal gut motility, altered gut signalling (visceral hypersensitivity)

Question 10

What are the main symptoms of IBS?

Answer 10

ABDOMINAL pain, pain relieved on defecation, bloating, change in bowel habit, mucus and fatigue

Question 11

What is an example of a differential diagnosis for IBS?

Answer 11

1. Coeliac disease.
2. Lactose intolerance.
3. Bile acid malabsorption.
4. IBD.
5. Colorectal cancer.

Question 12

What investigations might you do in someone who you suspect has IBS?

Answer 12

1. Bloods - FBC, U+E, LFT.
2. CRP.
3. Coeliac serology.

Question 13

What is the main treatment for IBS?

Answer 13

Early: Education, reassurance, dietary modification e.g. FODMAP.

Moderate: Pharmacotherapy and psychological treatments:

• Antispasmodics for pain.
• Laxatives for constipation.
• Anti-motility agents for diarrhoea.
• CBT and hypnotherapy.

Severe: MDT approach, referral to specialist pain treatment centres.
- Tri-cyclic anti-depressants.

Question 14

What investigations would be carried out for IBD?

Answer 14

1) Bloods: FBC, ESR, CRP
2) Faecal Calprotectin
3) Flexible sigmoidoscopy
4) Colonoscopy