Lecture 33 Psychological Aspects of Gastrointestinal Disease

Question 1

Give examples of organic diseases

Answer 1

IBD
Cancer
Systemic sclerosis

Question 2

Give examples of functional GI Diseases

Answer 2

o	Upper GI
•	Reflux
•	Functional dyspepsia
•	Nausea vomiting syndrome
o	Intestinal
•	IBS
o	Biliary Disease
•	Sphincter of Oddi Dysfunction

Question 3

What is the difference between structural and functional GI diseases

Answer 3

In functional the structure of gut is normal but does not function normally

Question 4

Assessment of GI ideas

Answer 4

•	History
o	Timeline: gradually changed overtime from when you were younger
•	Physical examination
o	Nutritional assessment
o	Mental state assessment 
•	Investigation
o	Tailored to patient

Question 5

Psychological problems caused by GI disease

Answer 5

• Conditioning
• Nausea and vomiting
• Loss of appetite- weight loss
• Diarrhoea
• Sexual problems
• Stress- increase gut activity- worried and more stressed

Question 6

Primary psychological problems presenting as GI disease

Answer 6

• Stress
• Anxiety
• Depression
• Somatisation- turns physical
• Eating disorders
• Mental state examination

Question 7

Drugs that can cause GI disease

Answer 7

•	Opiates
o	Prescribed
o	Non-prescribed
o	Illicit
•	Amphetamines
•	Cocaine
•	Anticholinergics
•	Antidepressants
o	Tricyclics
o	SSRI

Question 8

What is refeeding syndrome

Answer 8

• When an individual has not eaten in a long time:
• Adapted starvation
o Reduced intake of carbohydrate
o Reduced secretion of insulin
• Main sources of energy are fat and protein
o Reduced intracellular phosphate
o Extra cellular phosphate may be normal
• Refeeding with carbohydrate
• Rapid rise in insulin and glucose
• Extracellular ions being pulled into cells- magnesium, potassium etc.
• Potassium plasma levels decline rapidly- destabilise the heart
• Rapid generation of ATP- Hypophosphatemia rapidly develops

Question 9

Criteria for determining people at high risk of developing referring syndrome

Answer 9

• BMI less than 16kg/m2
• Unintentional weight loss greater than 15% within the last 3-6months
• Little or no nutritional intake for more than 10 days
• Low levels pf phosphate, potassium, magnesium prior to feeding

Question 10

Which group of people is referring syndrome much more common in

Answer 10

Drug and alcohol abusers

Question 11

What is treatment for referring syndrome

Answer 11

o Correct fluid depletion
o Thiamine at least 30 mins before feeding starts
o Feed @ 5-10 kcal/kg over 24 hours
o Gradual increase to requirement over 1 week
o Replace intracellular ions
– Phosphate (IV) below 0.3mmol/l- 40 mmol in 500mls 5% dextrose over 6 hours
– K < 2.5 mmol/l
– Mg <0.5mmol/l- 6g 50% MgSO4 in 500ml 5% dextrose 6-12 hours
– Thiamine- Vitamin- brain damage if too low

Question 12

What is the difference between an eating disorder and disorders eating

Answer 12

• Eating disorders- characteristics set of features
• Disordered eating- can’t eating large meals
• Lots of conditions produce disordered eating
-Crohn’s
-Coeliac
-Missing false teeth

Question 13

Describe binge eating

Answer 13

• Binges, purging
• But fail to compensate- gain weight over nourished
• Fear of gaining weight

Question 14

Describe Bulimia nervosa

Answer 14

• Restriction
• Binges
• Purges
• Normal or near normal weight

Question 15

Describe anorexia nervosa

Answer 15

•	Restriction- significant weight loss
•	Obsessive far of gaining weight
-Perfectionism
-Significantly impaired decision making (SIDMA)
•	Body dysmorphia
-Distorted self-image
•	Over-exercising
•	Amenorrhoea