Psychological aspects of GI disease Flashcards
acute organic diseases?
Patient’s perception
May be different from yours.
Cancer fears
Confusion between IBD and IBS
Food “sensitivity” and “allergy”
Restriction diets.
chronic organic diseases?
IBD
Surgery
Stomas
Other progressive conditions
Cancers of GI tract
All carry huge fears
what are functional GI disease?
Functional gastrointestinal disorders (FGID) are a group of disorders characterised by chronic gastrointestinal (GI) symptoms (eg abdominal pain, dysphagia, dyspepsia, diarrhoea, constipation and bloating) in the absence of demonstrable pathology on conventional testing.
who does functional GI disease more commonly affect?
younger people
what parts of the gut does functional GI disease affect?
Every part of the gut
upper GI
Intestinal
Biliary disease
what are functional GI diseases of the upper GI?
Reflux
Functional dyspepsia
Nausea vomiting syndromes
what are functional GI diseases of the intestinal GI?
IBS
what are functional GI diseases of biliary disease?
sphincter of oddi dysfunction
what is important to notice abut functional GI disease?
Symptoms are genuine
Can be very severe.
“Visceral sensitivity”
what is the mulifactorial aetiology of functional GI disease?
Motility
Gut hormones
Gut microbiome
Diet
Increased visceral sensation
Psychological factors.
How do you assess functional GI disease?
History
Time line
Physical examination
Nutritional assessment
Mental state assessment.
Investigation
Tailored to the needs of the patient
Age, length of history etc.
what are psychological problems caused by GI disease?
Conditioning
Nausea and vomiting
Loss of appetite
Weight loss
Diarrhoea
Sexual problems
“Stress”
what are primary psychological problems presenting as GI disease?
Stress
Anxiety
Depression
Somatisation
Eating disorders
Mental state examination
What do you think about your symptoms?
what are drugs that can have an effect on the GI system?
Opiates
Prescribed
Non prescribed
Illicit
Amphetamines
Cocaine
Anticholinergics
Antidepressants.
Tricyclics
SSRI
how do you exclude a p
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, when patient has one or more of the following?
Patient has one or more of the following:
BMI less than 16 kg/m2
unintentional weight loss greater than 15% within the last 3–6 months
little or no nutritional intake for more than 10days
low levels of potassium, phosphate or magnesium prior to feeding.
What is the criteria for determining people at high risk of developing refeeding problems, when patient has two or more of the following?
BMI less than 18.5 kg/m2
unintentional weight loss greater than 10% within the last 3–6 months
little or no nutritional intake for more than 5 days
a history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics.
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?
Crohn’s
Coeliac disease
Missing false teeth
when do you have to replace phosphate and what is used?
Phosphate (IV) below 0.3 mmol/l
40 mmol in 500mls 5%dextrose over 6 hrs
when are you required to replace potassium?
K < 2.5 mmol/l
when are you required to replace magnesium and what is used?
Mg <0.5mmol/l
6g 50% MgSO4 in 500ml 5%dextrose 6 – 12 hrs
What are the different categories of eating disorders?
Binge eating disorder
Bulminia nervosa
Anorexia nervosia
What is a binge eating disorder?
Binges, purging
But fail to compensate
Gain weight
what is bulimia nervosa?
Restriction
Binges
Purging
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
