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Digestive MBChB 2 > Lecture 29; IBS and IBD > Flashcards

Lecture 29; IBS and IBD Flashcards

1
Q

What are functional gut disorders?

A

Symptoms without pathology

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2
Q

Whats found in functional gut disorders?

A 
No structural or tissue abnormality
Constitution without overt pathology
Multiple factors;
 - Disturbed motility
 - Visceral hypersensitivity
 - Brain-gut dysfunction
 - Psychological factors
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3
Q

What does the lack of pathology mean for investigation?

A
  • No overt pathology means no diagnostic test
  • No biochemical abnormality with conventional testing
  • No histological or radiological features

i.e Cant tell cause

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4
Q

Where does functional gut disorder occur?

A

In any part of the gut

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5
Q

What are some examples of functional gut disorders in the oesophagus?

A

Globus -> Sensation of lump in throat

Functional heartburn -> i.e symptoms of reflux w/o evidence of gord

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6
Q

What are some examples of functional gut disorders in the stomach?

A

Functional dyspepsia -> Epigastric pain, no pathology

Functional vomiting / cyclical vomiting syndrome -> No diagnostic cause and no psychiatric cause.

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7
Q

What are some examples of functional gut disorders in the Bowel - SI/LI?

A

IBS -> i.e constipation or diarrhoea , bloating

Functional abdo pain -> No diagnostic abnormalities

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8
Q

How can functional gut disorders be diagnosed?

A

It is a diagnosis of exclusion. No pathology.

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9
Q

What are the symptoms of IBS?

A

Swinging bowel habit. Constipation -> Diarrhoea

Cardinal symptom: Abdo pain typically relieved with defaecation.

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10
Q

What are the associated symptoms of IBS?

A
  • Urgency
  • Feeling of incomplete evacuation
  • Passage of mucous
  • Abdo bloating
  • Excess flatus

(May occur after gastroenteritis)

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11
Q

What are some systemic symptoms associated with IBS?

A
  • Fatigue
  • Backache, headache
  • Altered bowel motility = urinary symptoms
  • Palpitations
  • Poor sleep quality
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12
Q

What are the alarm symptoms with a suspected IBS?

A
  • Older patient (over 50)
  • Short history
  • Nocturnal diarrhoea/pain
  • Rectal bleeding
  • Anemia or iron deficiency
  • Weight loss
  • Vomiting
  • Family history of colon cancer
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13
Q

What are the potential pathophysiological causes of IBS?

A
  • Altered gut motility, i.e exaggerated with diarrhoea, reduced with constipation
  • Visceral hypersensitivity -> balloon distension
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14
Q

What are the potential causes of visceral hypersensitivity in IBS?

A
  • Central sensitisation
  • Gate control theory (open, thus sensed)
  • Effect of stress
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15
Q

Whats the treatment of IBS?

A
  • Conventional
  • Dietary
  • Natural
  • Lifestyle (General advice about eating frequency, good health habits etc)
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16
Q

Whats the specific treatment of IBS?

A

Fibre supplements
Laxatives for constipation
Anti-motility drugs for bowel frequency
Low-dose tricyclic antidepressants (neuropathic pain)

17
Q

What can be excluded from the diet to help with IBS?

A
  • Food intolerances instead of allergy
  • FODMAP diets
  • Probiotics (strain dep.)
18
Q

Whats IBD? and some examples

A

Inflammatory Bowel Disease (Genetic and environmental factors)

Ulcerative colitis
Crohns disease

19
Q

Whats the genetics of IBD?

A
  • 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
20
Q

How does the environment influence IBD?

A
  • Common in western countries
  • Smoking increases CD
  • Smoking protective in UC
21
Q

How does IBD occur?

A
  • Not fully understood
  • Disruption of the integrity of epithelial barrier
  • Dysregulation of innate and adaptive immunity = abnormal immune responses
  • Certain microbes might trigger IBD
22
Q

Whats the pathology of UC?

A
  • 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.
23
Q

Whats the histology of UC?

A
  • 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)
24
Q

What is the clinical presentation of ulcerative colitis?

A
  • Diarrhoea with blood
  • Frequent bowel motions with urgency
  • Abdo discomfort
  • Fever, malaise, weight loss (constitutional symptoms)
25
Q

What lab tests can be done for UC?

A

Inflam

  • Raised ferritin
  • Raised feacal calprotectin
  • Mild aneamia
  • Platelets, neutrophils raised

Prolonged bleeding may result in iron deficiency with/without aneamia

26
Q

Whats the pathology of CD?

A
  • Any part GI tract, common ilium and colon
  • Skip lesions (discontinous)
  • Transmural inflammation

Starts with small ulcers on mucosa -> ulcers with fissures

Distinct cobblestone appearance

27
Q

Whats the histology of CD?

A

Transmural inflammation (entire depth of colon wall)

Non-caseating (think cheese)/ non-necrotising granulomas (although other conditions can cause this)

28
Q

What are the clinical presentations of CD?

A
  • Presentation depends on part of GI tract involved and clinical sub type
  • Inflammatory
  • Stricturing
  • Fistuling
  • Perianal
29
Q

What are some CD inflammatory conditions?

A
  • Colitis
  • Ileitis
  • Gastritis
  • Duodenitis
30
Q

What does stricturing CD result in?

A

Stricturing can result in;

  • Abdo pain and distension
  • Vomiting
  • Bowels not opening

Initially inflammatory i.e due to oedema, over time becomes fibrotic i.e due to scarring.

31
Q

What is CD fistuling?

A

Fistula is an abnormal connection/tract between the gut and another organ/vessel

32
Q

What is meant by perianal CD?

A
  • Perianal abcess
  • Perianal fistula
  • Anal fissure
33
Q

What are the lab tests involved in CD?

A
  • Inflammatory markers
  • Prolonged bleeding -> Anemia, iron def, B12 def
  • Malabsoprtion may also contribute to this
34
Q

Whats the treatment of IBD?

A
  • Anti-inflams
  • Steroids
  • Immunosuppression
  • Anti-tumor necrosis factor
35
Q

What are surgical possibilities in UC or CD?

A

UC -> Colectomy is curative

CD -> No cure

Digestive MBChB 2 (31 decks)

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