IBD And Functional Disorders Flashcards
Difference between structural and functional disorders?
Structural= detectable pathology eg cancer
Functional=no detectable pathology (software fault)
2 types of functional GI disorders
Oesophageal spasm
Non-ulcer dyspepsia
S+S of non-ulcer dyspepsia
Dyspepsic type pain
No ulcer on endoscopy
H.Pylori status varies
Probably not a single
Tx for non-ulcer dyspepsia
If -ve for alarm symptoms and H.Pylori status =treat symptomatically
If H.pylori +ve= eradication therapy
Ix for non-dyspepsic ulcers
Endoscopy
Nausea vs vomiting vs retching
Nausea=sensation of feeling sick
Retching=dry heave, antrum contracts and glottis closed
Vomiting=contents expelled
What does vomiting immediately after food, after more than 1hr and more than 12 hours?
Immediately=psychogenic
1hr or more=pyloric obstruction, motility disorders
12 hours= obstruction
Causes of functional nausea and vomiting
Drugs Pregnancy Migraine Cyclical vomiting syndrome -childhood onset often -recurrent episodes 2-3x a year to 2-3x a month Alcohol
Describe psychogenic vomiting syndrome
Often young women
Often for years
Maybe no preceding nausea
May be self induced (overlap with bulimia)
Appetite usually not disturbed but may lose weight die to all the vomiting
Often stops when admitted
What do you want to know in a history for functional GI problems?
What’s normal for them Change in frequency and consistency Any blood or mucous The duration Soiling Use the Bristol stool charts Any indications for systemic disease Careful abdominal examination Rectal exam FOBT/FIT Any alarm symptoms
What’re the alarm symptoms?
Age>50 Short symptom history=recent onset Unintentional weight loss Nocturnal symptoms=shouldn’t happen Men FH of bowel/ovarian cancer Anemia Rectal bleeding Recent antibiotic use Abdominal mass
Ix for gut function change
FBC Blood glucose U+E Thyroid -hypo=slow passage -hyper=fast passage Coeliac surgery FIT Sigmoidoscopy
Systemic causes of constipation
Diabetes
Hypothyroidism
Hypercalcemia
Neurogenic causes of constipation
Autonomic neuropathies Parkinson’s disease Strokes MS Spina bifida
Organic causes of constipation
Strictures
Tumours
Diverticular disease
Anal fissure
Functional causes of constipation
Megacolon
Idiopathic constipation
Depression
Psychosis
S+S of IBS
Abdominal pain
- vague
- burning
- bloating
- -often prominent
- -wind and flatulence
- -relaxation of abdominal wall muscles
- -mucus in stool
Altered bowel habits
- constipation (IBS-C)
- diarrhoea (IBS-D)
- both (IBS-M)
- variability
- urgency
Ix for IBS
Blood analysis FBC U+E LFT Ca Coeliac serology Stool culture CRP Cal protectin -differentiates between IBD and IBS -high levels indicate inflammation -a low calprotectin indicates IBS rather than IBD FIT
Tx for IBS (pain, bloating, constipation and diarrhoea)
Pain=antispasmodics, Linaclotide (IBS-C)
Bloating=some probiotics, linaclotide (IBS-C), avoid bulking agents/fibre
Constipation=laxatives
- bulking agents/fibres=episodic
- softeners=adjuvant
- stimulants=occasional
- osmotics=regular
diarrhoea=antimotility agents FODMAP
Hypotherapy=has effects for 10 years Relaxation training Cognitive behaviour therapy -identifying triggers -responding more appropriately Psychodynamic interpersonal therapy -understanding how emotions and bowel symptoms interrelate
What causes IBS?
Altered motility
- muscular contractions may be stronger and more frequent than normal
- In IBS-C contraactions may be reduced
- brain hears the gut too loudly
- heightened gut awareness
- biopsychosocial link
Visceral HT
Stress, anxiety and depression
-stress response may be chronic
-in IBS, gut is more sensitive to stress
