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Alimentary System > Psychological aspects of GI disease > Flashcards

Psychological aspects of GI disease Flashcards

1
Q

acute organic diseases?

A

Patient’s perception

May be different from yours.

Cancer fears

Confusion between IBD and IBS

Food “sensitivity” and “allergy”
Restriction diets.

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2
Q

chronic organic diseases?

A

IBD
Surgery
Stomas
Other progressive conditions
Cancers of GI tract
All carry huge fears

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3
Q

what are functional GI disease?

A

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.

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4
Q

who does functional GI disease more commonly affect?

A

younger people

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5
Q

what parts of the gut does functional GI disease affect?

A

Every part of the gut
upper GI
Intestinal
Biliary disease

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6
Q

what are functional GI diseases of the upper GI?

A

Reflux
Functional dyspepsia
Nausea vomiting syndromes

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7
Q

what are functional GI diseases of the intestinal GI?

A

IBS

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8
Q

what are functional GI diseases of biliary disease?

A

sphincter of oddi dysfunction

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9
Q

what is important to notice abut functional GI disease?

A

Symptoms are genuine
Can be very severe.
“Visceral sensitivity”

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10
Q

what is the mulifactorial aetiology of functional GI disease?

A

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

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11
Q

How do you assess functional GI disease?

A

History
Time line

Physical examination
Nutritional assessment
Mental state assessment.

Investigation
Tailored to the needs of the patient
Age, length of history etc.

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12
Q

what are psychological problems caused by GI disease?

A

Conditioning
Nausea and vomiting
Loss of appetite
Weight loss
Diarrhoea
Sexual problems
“Stress”

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13
Q

what are primary psychological problems presenting as GI disease?

A

Stress
Anxiety
Depression
Somatisation
Eating disorders
Mental state examination
What do you think about your symptoms?

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14
Q

what are drugs that can have an effect on the GI system?

A

Opiates
Prescribed
Non prescribed
Illicit

Amphetamines

Cocaine

Anticholinergics

Antidepressants.
Tricyclics
SSRI

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15
Q

how do you exclude a p

A

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

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16
Q

When does adaptive starvation occur?

A

Reduced intake of carbohydrates

Reduced secretion of insulin

17
Q

What are the main sources of energy during adaptive starvation?

A

Fats and proteins

18
Q

How does intra and extracellular phosphate change in adaptive starvation?

A

Intracellular phosphate is reduced

Extracellular phosphate may be normal

19
Q

What are consequences of adaptive starvation due to low expenditure of energy?

A

Lethargy

Lack of physical activity

Atrophic gut, heart and muscles

Low micronutrient reserves

20
Q

What does refeeding with carbohydrates cause in someone with adaptive starvation?

A

Rapid rise in insulin

Rapid generation of ATP

Phosphate moves into cells

Hypophosphataemia rapidly develops

21
Q

What is the criteria for determining people at high risk of developing refeeding problems, when patient has one or more of the following?

A

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.

22
Q

What is the criteria for determining people at high risk of developing refeeding problems, when patient has two or more of the following?

A

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.

23
Q

What things are considered when deciding if someone is at risk of developing refeeding problems?

A

BMI

Unintentional weight loss

Little or no nutritional intake

Low levels of potassium, phosphate or magnesium prior to feeding

24
Q

What is the treatment for refeeding syndrome?

A

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

25
Q

At what rate should people with refeeding syndrome be fed?

A

5-10 kcal/kg/ over 24 hours

Gradual increase to requirement over 1 week

26
Q

What should be remembered about disordered eating and eating disorder?

A

Crohn’s

Coeliac disease

Missing false teeth

27
Q

when do you have to replace phosphate and what is used?

A

Phosphate (IV) below 0.3 mmol/l

40 mmol in 500mls 5%dextrose over 6 hrs

28
Q

when are you required to replace potassium?

A

K < 2.5 mmol/l

29
Q

when are you required to replace magnesium and what is used?

A

Mg <0.5mmol/l

6g 50% MgSO4 in 500ml 5%dextrose 6 – 12 hrs

30
Q

What are the different categories of eating disorders?

A

Binge eating disorder

Bulminia nervosa

Anorexia nervosia

31
Q

What is a binge eating disorder?

A

Binges, purging
But fail to compensate
Gain weight

32
Q

what is bulimia nervosa?

A

Restriction
Binges
Purging
Normal or near normal weight.

33
Q

What are symptoms/signs of anorexia nervosa?

A

Restriction of eating

Obsessive fear of gaining weight

Body dysmorphia (distorted self-image)

Over exercising

Amenorrhoea

33
Q

What is amenorrhoea?

A

lack of periods in women

34
Q

What are some of the behaviours peopole with anorexia nervosa have in the pursuit of thinness?

A

Self-starvation

Self-induced vomiting

Compulsive activity and exercise

Use of laxatives

Diet pills

Herbal medicines

Deliberate exposure to the cold

35
Q

What are the general principles for managing anorexia?

A

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

36
Q

What are different kinds of specialist help for anorexia?

A

Liaison psychiatry

Specialist knowledge of eating disorders

Knowledge of Mental Health Act

37
Q

What are simple measures for treating eating disorders?

A

IV fluids

Pabrinex (standard multivitamin IV preparation)

Dietetic review

Maybe NG tube

Alimentary System (44 decks)

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