Pathological Aspects of GI Disease/Eating Disorders

Question 1

Functional GI diseases examples: Upper

Answer 1

Upper GI:
-Reflux
-Functional dyspepsia
-Nausea vomiting syndromes

Intestinal:
-IBS

Biliary disease:
-Sphincter of Oddi Dysfunction

Question 2

factors that can affect Multifactorial aetiology of functional GI disease

Answer 2

Motility
Gut hormones
Gut microbiome
Diet
Increased visceral sensation
Psychological factors.

Question 3

Psychological problems caused by GI Disease

Answer 3

-Conditioning (when one trigger causes a certain response, eg bell for saliva in dogs)
-Nausea and vomiting
-Loss of appetite
-Weight loss
-Diarrhoea
-Sexual problems
-“Stress”

Question 4

What psychological isses can affect the gut?

Answer 4

Stress
Anxiety
Depression
Somatisation
Eating disorders

So very important to do a mental state examination:
What do you think about your symptoms?

Question 5

What drugs can affect the gut?

Answer 5

-Opiates (Prescribed, Non prescribed, Illicit)
-Amphetamines
-Cocaine
-Anticholinergics
-Antidepressants. (Tricyclics, SSRI)

Question 6

What is refeeding syndrome?

Answer 6

After a period of starvation, sudden influx of carbs causes:
-Rapid rise in insulin
-Rapid generation of ATP
-Phosphate moves into cells
-Hypophosphataemia rapidly develops

Question 7

What happens to the body on starvationb?

Answer 7

-Reduced insulin secretion
- reduced intracellular phosphate (extracellular may be normal)
- atrophy
-low on micronutrients

Question 8

How dcan you treat hyperkalaemia?

Answer 8

insulin and glucose (drives hyperkalaemia from the plasma into cells, which s much safer)

Question 9

Risk factors of refeeding syndrome

Answer 9

1 of:
-BMI under 16
-unplanned weightloss over 15%
-little/no food 10 days
-low K/Mg/phosphotase

OR 2 of:
-BMI under 18.5
-10-15% unplanned weight loss (3-6 mo.)
-little/no food for 5 days
-a history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics.

Question 10

Refeeding treatment

Answer 10

Correct fluid depletion [cautiously]
Thiamine at least 30 mins before feeding starts
Feed @ 5 - 10 kcal/kg over 24 hrs
Gradual increase to requirement over 1 week

Question 11

When do we replace:
-Phosphotase, K, Mg, Thiamine

Answer 11

-Phosphate (IV) below 0.3 mmol/l (by 40 mmol in 500mls 5%dextrose over 6 hrs)
-K < 2.5 mmol/l
-Mg<0.5mmol/l
(6g 50% MgSO4 in 500ml 5%dextrose 6 – 12 hrs)
-Thiamine

Question 12

Disordered eating vs eating disorderrs

Answer 12

Disordered eating = unconventional

Eating disorder = serious illness

Question 13

3 big areas of eating disorders

Answer 13

Binge eating, Bulimia Nervosa, Anorexia Nervosa

Question 14

What is Binge eating disorde?

Answer 14

Binge eating folowed by puking but not compensating enough so gains weight

Question 15

What is Bulimia Nervosa?

Answer 15

Binge eating, puking/restriction, normal weight

Question 16

What is Anorexia Nervosa?

Answer 16

Restriction, weight loss, extreme fear of gaining weight, distorted self image, might over exercise and miss periods (Amenorrhoea)

Question 17

Eating disorders… Need help from who?

Answer 17

Psychiatrist!!!

Question 18

Anorexia treatment

Answer 18

Psychiatric help, rehydrate, replace micronutrients, ECG with monitoring if required

Question 19

What psychologial and social problems are in the background of eating disorders? (can be)

Answer 19

Abuse, fear of diagnosis