Lecture 29; IBS and IBD Flashcards
What are functional gut disorders?
Symptoms without pathology
Whats found in functional gut disorders?
No structural or tissue abnormality Constitution without overt pathology Multiple factors; - Disturbed motility - Visceral hypersensitivity - Brain-gut dysfunction - Psychological factors
What does the lack of pathology mean for investigation?
- No overt pathology means no diagnostic test
- No biochemical abnormality with conventional testing
- No histological or radiological features
i.e Cant tell cause
Where does functional gut disorder occur?
In any part of the gut
What are some examples of functional gut disorders in the oesophagus?
Globus -> Sensation of lump in throat
Functional heartburn -> i.e symptoms of reflux w/o evidence of gord
What are some examples of functional gut disorders in the stomach?
Functional dyspepsia -> Epigastric pain, no pathology
Functional vomiting / cyclical vomiting syndrome -> No diagnostic cause and no psychiatric cause.
What are some examples of functional gut disorders in the Bowel - SI/LI?
IBS -> i.e constipation or diarrhoea , bloating
Functional abdo pain -> No diagnostic abnormalities
How can functional gut disorders be diagnosed?
It is a diagnosis of exclusion. No pathology.
What are the symptoms of IBS?
Swinging bowel habit. Constipation -> Diarrhoea
Cardinal symptom: Abdo pain typically relieved with defaecation.
What are the associated symptoms of IBS?
- Urgency
- Feeling of incomplete evacuation
- Passage of mucous
- Abdo bloating
- Excess flatus
(May occur after gastroenteritis)
What are some systemic symptoms associated with IBS?
- Fatigue
- Backache, headache
- Altered bowel motility = urinary symptoms
- Palpitations
- Poor sleep quality
What are the alarm symptoms with a suspected IBS?
- Older patient (over 50)
- Short history
- Nocturnal diarrhoea/pain
- Rectal bleeding
- Anemia or iron deficiency
- Weight loss
- Vomiting
- Family history of colon cancer
What are the potential pathophysiological causes of IBS?
- Altered gut motility, i.e exaggerated with diarrhoea, reduced with constipation
- Visceral hypersensitivity -> balloon distension
What are the potential causes of visceral hypersensitivity in IBS?
- Central sensitisation
- Gate control theory (open, thus sensed)
- Effect of stress
Whats the treatment of IBS?
- Conventional
- Dietary
- Natural
- Lifestyle (General advice about eating frequency, good health habits etc)
Whats the specific treatment of IBS?
Fibre supplements
Laxatives for constipation
Anti-motility drugs for bowel frequency
Low-dose tricyclic antidepressants (neuropathic pain)
What can be excluded from the diet to help with IBS?
- Food intolerances instead of allergy
- FODMAP diets
- Probiotics (strain dep.)
Whats IBD? and some examples
Inflammatory Bowel Disease (Genetic and environmental factors)
Ulcerative colitis
Crohns disease
Whats the genetics of IBD?
- First degree relatives 20x more likely
- More important in CD than UC
- Uncommon in ethnic groups i.e maori and pacifica
- 85% dont family history
How does the environment influence IBD?
- Common in western countries
- Smoking increases CD
- Smoking protective in UC
How does IBD occur?
- Not fully understood
- Disruption of the integrity of epithelial barrier
- Dysregulation of innate and adaptive immunity = abnormal immune responses
- Certain microbes might trigger IBD
Whats the pathology of UC?
- DISEASE LIMITED TO COLON
- Begins rectum and spreads proximally (clear line of progression)
- Mucosal inflammation (diffuse or granular)
- No macroscopic ulceration except in severe disease.
Whats the histology of UC?
- Mucosal inflammation only (chronic inflam filtrate)
- Crypt distortion and atrophy
- Neutrophils invade crypts (crypt abcess)
- Loss of goblet cells
- Paneth cell metaplasia (i.e found where they arent normally)
What is the clinical presentation of ulcerative colitis?
- Diarrhoea with blood
- Frequent bowel motions with urgency
- Abdo discomfort
- Fever, malaise, weight loss (constitutional symptoms)
