IBD And Functional Disorders Flashcards

1
Q

Difference between structural and functional disorders?

A

Structural= detectable pathology eg cancer

Functional=no detectable pathology (software fault)

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2
Q

2 types of functional GI disorders

A

Oesophageal spasm

Non-ulcer dyspepsia

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3
Q

S+S of non-ulcer dyspepsia

A

Dyspepsic type pain
No ulcer on endoscopy
H.Pylori status varies
Probably not a single

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4
Q

Tx for non-ulcer dyspepsia

A

If -ve for alarm symptoms and H.Pylori status =treat symptomatically

If H.pylori +ve= eradication therapy

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5
Q

Ix for non-dyspepsic ulcers

A

Endoscopy

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6
Q

Nausea vs vomiting vs retching

A

Nausea=sensation of feeling sick
Retching=dry heave, antrum contracts and glottis closed
Vomiting=contents expelled

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7
Q

What does vomiting immediately after food, after more than 1hr and more than 12 hours?

A

Immediately=psychogenic
1hr or more=pyloric obstruction, motility disorders
12 hours= obstruction

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8
Q

Causes of functional nausea and vomiting

A
Drugs 
Pregnancy 
Migraine 
Cyclical vomiting syndrome 
-childhood onset often
-recurrent episodes 2-3x a year to 2-3x a month 
Alcohol
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9
Q

Describe psychogenic vomiting syndrome

A

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

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10
Q

What do you want to know in a history for functional GI problems?

A
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
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11
Q

What’re the alarm symptoms?

A
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
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12
Q

Ix for gut function change

A
FBC
Blood glucose 
U+E
Thyroid 
-hypo=slow passage
-hyper=fast passage 
Coeliac surgery 
FIT
Sigmoidoscopy
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13
Q

Systemic causes of constipation

A

Diabetes
Hypothyroidism
Hypercalcemia

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14
Q

Neurogenic causes of constipation

A
Autonomic neuropathies 
Parkinson’s disease
Strokes
MS
Spina bifida
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15
Q

Organic causes of constipation

A

Strictures
Tumours
Diverticular disease
Anal fissure

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16
Q

Functional causes of constipation

A

Megacolon
Idiopathic constipation
Depression
Psychosis

17
Q

S+S of IBS

A

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
18
Q

Ix for IBS

A
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
19
Q

Tx for IBS (pain, bloating, constipation and diarrhoea)

A

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
20
Q

What causes IBS?

A

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