Psychological aspects of GI disease

Question 1

name 3 functional diseases which effect the upper GI tract.

Answer 1

reflux
non ulcer dyspepsia
nausea vomiting syndrome (clinical vomiting syndrome)

Question 2

name a functional biliary disease.

Answer 2

sphincter of oddi dysfunction (post cholecystectomy dysfunction)

Question 3

what psychological problems can present as GI disease?

Answer 3

stress
anxiety
depression 
somatisation 
eating disorders

Question 4

what drugs can affect the gut?

Answer 4

opiates 
amphetamines
coccaine 
cannabis 
anticholinergics 
antidepressants

Question 5

how does referring occur?

Answer 5

when someone is in adapted starvation there is low intracellular phosphate.
when referring a with a high carb meal there is a rapid rise in insulin and a generation of ATP.
phosphate then moves into the cell causing hypophosphataemia
= cardiac arrest due to electrolyte dysturbance.

Question 6

what is the criteria for determining if someone is at risk of developing refeeding syndrome?

Answer 6

patient has one or more of the following:
BMI <16
little or no nutritional intake for the past 10 days
unintentional weight loss >15% past 3 months
low levels of K, phosphate or Mg

or 2 or more of the following;
BMI <18
little/no intake for past 5 days
unintentional weight loss 10% past 3 months
history of alcohol abuse or drugs i.e. chemotherapy, insulin, antacids, or diuretics

Question 7

how would you treat someone who is at risk of referring syndrome?

Answer 7

treat slowly

give them 5-10kcal/kg over 24 hours

Question 8

If a patient has a GI diseases what psychological effects could this have on them and why?

Answer 8

Worry/anxiety about the possibility of a stoma (IBD)
Anxiety of outings due to urgency (IBS)
Worries of cancer of the GI tract

Question 9

What are the causes of functional GI diseases?

Answer 9

Gut microbiome 
Gut hormones 
Visceral hypersensitivity 
Psychological factors 
Gut motility 
Diet