Gastrointestinal conditions Flashcards
List six conditions of the GI tract.
constipation irritable bowel syndrome (IBS) haemorrhoids cancer anal fissures and fistula inflammatory bowel disease (IBD)
What is the prevalence of constipation in the UK?
12-12.8 per 1000
worldwide prevalence estimated 14%
2-3 times higher in women than in men
What is the prevalence of IBS?
10-20% of the general population
people aged 20-30 years most often affected
twice as common in women as in men
What is the prevalence of haemorrhoids?
13-36% of the general population
peak prevalence occurs between the ages of 45-65 years in men and women
What is the prevalence of colorectal cancer?
fourth most common cancer in the UK
>41,000 new cases diagnosed each year
risk factors: increasing age, genetics and family history (familial adenomatous polyposis, Lynch syndrome), IBD, dietary and lifestyle factors
What is the prevalence of anal fissures (AF)?
around 1 in 350 people
common in people aged 15-40 years
What is the prevalence of IBD (ulcerative colitis (UC) and Crohn’s disease (CD)) in the UK?
UC - 146,000
CD - 115,000
UC - peak incidence 15-25 years, 2nd peak 55-65 years
What is irritable bowel syndrome (IBS)?
a chronic, relapsing and often life‑long disorder
the exact cause is unknown but it is likely to involve a mix of genetic and environmental factors
symptoms can overlap with other GI disorders (e.g. non‑ulcer dyspepsia, coeliac disease)
people with IBS present to primary care with a wide range of symptoms
List some of the possible biological mechanisms that lead to IBS.
visceral hypersensitivity
abnormal gastrointestinal immune function
changes in colonic microbiota
abnormal autonomic activity
abnormal central pain processing of afferent gut signals (altered ‘brain-gut interactions’)
abnormal gastrointestinal motility
List some of the possible causes or risk factors for IBS.
genetics - twin studies and family studies confirm familial aggregation
enteric infection (e.g. following gastroenteritis)
GI inflammation (e.g. secondary to IBD)
diet (e.g. alcohol, caffeine, spicy and fatty foods) - up to 90% of people report that food triggers symptoms
certain drugs (e.g. antibiotics)
psychosocial factors (e.g. stress, anxiety) - influence the physiological functioning of the GI tract via the brain-gut axis
List five signs of IBS.
bloating (more common in women) change in stool frequency altered stool form rectal mucus altered stool passage (straining, urgency, or incomplete evacuation)
List six symptoms of IBS.
abdominal pain symptoms worse after eating lethargy nausea headache back pain
What factors are required for a diagnosis of IBS?
at least two of the six symptoms for at least 6 months according to:
Abdominal pain and discomfort
Bloating
Change in bowel habit
What further consideration is given to confirm a diagnosis of IBS?
if abdominal pain or discomfort is relieved by defecation or associated with altered bowel frequency or stool form
What is the Rome IV criteria for IBS classification?
four sub-types
classified by the predominant stool type
it is recognised they exist on a spectrum depending on the person’s quantity, intensity, and severity of different symptoms
What are the four sub-types of the Rome IV criteria for IBS classification?
diarrhoea predominant (IBS-D) (most common) constipation predominant (IBS-C). mixed, fluctuating between diarrhoea and constipation (IBS-M) unclassified (IBS-U)
What is the Bristol stool type 1?
separate hard lumps, like nuts (hard to pass)
What is the Bristol stool type 2?
sausage shaped, but lumpy
What is the Bristol stool type 3?
like a sausage, but cracks on the surface
What is the Bristol stool type 4?
like a sausage or snake, smooth and soft
What is the Bristol stool type 5?
soft blobs with clear cut edges
What is the Bristol stool type 6?
fluffy pieces with ragged edges, a mushy stool
What is the Bristol stool type 7?
watery, no solid piece, entirely liquid
How do people with IBS present?
with varying symptom profiles, most commonly ‘diarrhoea predominant’, ‘constipation predominant’ or alternating symptom profiles
IBS diagnosis should be a consideration when an older person presents with unexplained abdominal symptoms
