Psychological Aspects of GI Disease

Question 1

name some upper GI functional diseases

Answer 1

> reflux
functional dyspepsia
nausea vomiting syndromes

Question 2

name an intestinal functional GI disease

Answer 2

IBS

Question 3

name a functional biliary disease

Answer 3

sphincter of oddi dysfunction

Question 4

how would you assess a functional GI disease?

Answer 4

> History: time line
physical examination: nutritional and mental assessment
investigation: tailored to the needs of patient, age, length of history

Question 5

what GI problems are associated with psychological issues?

Answer 5

> conditioning 
> nausea and vomiting
> loss of appetite
> diarrhoea
> sexual problems

Question 6

what psychological problems can present as GI disease?

Answer 6

> stress
> anxiety
> depression
> somatisation
> eating disorders

Question 7

what type of GI disease is more common in young people?

Answer 7

functional disease

Question 8

what is refeeding syndrome?

Answer 8

if a malnourished patient is refed too quickly they can die

Question 9

describe adapted starvation

Answer 9

the reduced carb intake means there is a reduced secretion of insulin

Question 10

what is the effect of fat and protein being the main sources of energy?

Answer 10

there is reduced intracellular phosphate

Question 11

what happens to the gut and heart muscles in starvation?

Answer 11

they atrophy

Question 12

describe step by step what happens when you try to refeed a starved patient with carbohydrates

Answer 12

> rapid rise in insulin
rapid generation of ATP
phosphate moves in the cells
hypophosphataemia rapidly develops

Question 13

what is the criteria for people who are at high risk of refeeding problems?

Answer 13

One/more of:
> BMI=16
> unintentional weight loss 15% within 3-6months
> little/no nutritional intake for 10days
> low k, phosphate, magnesium prior to feeding

Or 2/more of:
> BMI less than 18.5kg
> unintentional weight loss greater than 10% in 3-6 months
> little/no nutritional intake for 5 days
> history of drugs: alcohol, insulin, chemo, antacids, diuretics

Question 14

what is the treatment for a patient who is starving?

Answer 14

slow
> correct fluid depletion
> thiamine at least 30 mins before feeding begins
> feed @5-10kcal/kg over 24 hours
> gradual increase to requirement over 1 week
> 40mmol of phosphate in 500mls 5% dextrose over 6 hours
> 6g 50% MgSO4 in 500ml 5% dextrose 6-11 hours

Question 15

describe binge eating disorders

Answer 15

binges and then purges but there is compensation failure so eight is gained

Question 16

describe bulimia nervosa

Answer 16

there is restriction and binges which are then purged. there is normal to near normal weight.

Question 17

describe anorexia nervosa

Answer 17

> restriction causes significant weight loss
obsessive fear of gaining weight with significantly impaired decision making
body dysmorphia
over exercising
amenorrhoea