Psychological Aspects of Gastrointestinal Disease Flashcards
What are examples of psychological aspects of GI disease?
Organic disease
Functional GI disease
Psychological problems presenting as GI disease
Psychological problems caused by GI disease
Assessment
What should be remembered about fear and GI diseases?
Both acute and chronic GI diseases carry huge fears
Are functional GI diseases more common in younger or older people?
Younger people
What parts of the gut do functional GI diseases affect?
Every part of the gut
What are examples of upper GI functional diseases?
Reflux
Functional dyspepsia
Nausea vomiting syndromes
What is an example of an intestinal GI disease?
IBS
What is an example of a biliary functional GI disease?
Sphincter of Oddi dysfunction
What are the investigations and physical examination like for functional GI diseases?
Normal
What is some of the aetiology of functional GI diseases?
Motility
Gut hormones
Gut microbiome
Diet
Increased visceral sensation
Psychological factors
What are examples of psychological problems caused by GI disease?
Conditioning
Nausea and vomiting
Loss of appetite
Diarrhoea
Sexual problems
Stress
What are examples of psychological problems presenting as GI disease?
Stress
Anxiety
Depression
Somatisation
Eating disorders
What are examples of drugs that can cause GI problems?
Opiates
Amphetamines
Cocaine
Anticholinergics
Antidepressants
What is refeeding syndrome?
Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness
When does adaptive starvation occur?
Reduced intake of carbohydrates
Reduced secretion of insulin
What are the main sources of energy during adaptive starvation?
Fats and proteins
How does intra and extracellular phosphate change in adaptive starvation?
Intracellular phosphate is reduced
Extracellular phosphate may be normal
What are consequences of adaptive starvation due to low expenditure of energy?
Lethargy
Lack of physical activity
Atrophic gut, heart and muscles
Low micronutrient reserves
What does refeeding with carbohydrates cause in someone with adaptive starvation?
Rapid rise in insulin
Rapid generation of ATP
Phosphate moves into cells
Hypophosphataemia rapidly develops
What is the criteria for determining people at high risk of developing refeeding problems?
What things are considered when deciding if someone is at risk of developing refeeding problems?
BMI
Unintentional weight loss
Little or no nutritional intake
Low levels of potassium, phosphate or magnesium prior to feeding
What is the treatment for refeeding syndrome?
Correct fluid depletion (cautiously)
Thiamine at least 30 minutes before feeding starts
Feed at 5-10 kcal/kg over 24 hours
Gradual increase to requirement over 1 week
At what rate should people with refeeding syndrome be fed?
5-10 kcal/kg/ over 24 hours
Gradual increase to requirement over 1 week
What should be remembered about disordered eating and eating disorder?
They are different
What are examples of conditions that produce disordered eating?
Crohn’s
Coeliac disease
Missing false teeth
What are the different categories of eating disorders?
Binge eating disorder
Bulminia nervosa
Anorexia nervosia
What is a binge eating disorder?
Binges
Gain weight
What is bulminia nervosa?
Restriction
Binges
Normal or near normal weight
What are symptoms/signs of anorexia nervosa?
Restriction of eating
Obsessive fear of gaining weight
Body dysmorphia (distorted self-image)
Over exercising
Amenorrhoea
What is amenorrhoea?
Lack of periods in women
What are some of the behaviours peopole with anorexia nervosa have in the pursuit of thinness?
Self-starvation
Self-induced vomiting
Compulsive activity and exercise
Use of laxatives
Diet pills
Herbal medicines
Deliberate exposure to the cold
What are the general principles for managing anorexia?
Firm and consistent approach
Team approach (dietitian, ward nurses, decide on mangement as a team)
May need NG feeding
Watch for refeeding syndrome
Get specialist help
What are different kinds of specialist help for anorexia?
Liaison psychiatry
Specialist knowledge of eating disorders
Knowledge of Mental Health Act
What are simple measures for treating eating disorders?
IV fluids
Pabrinex (standard multivitamin IV preparation)
Dietetic review
Maybe NG tube
