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Systems: Alimentary AB > Psychological Aspects of GI Disease/ Eating Disorders > Flashcards

Psychological Aspects of GI Disease/ Eating Disorders Flashcards

1
Q

What psychological influences are there on organic acute disease?

A
  • Patients perception
  • Cancer fears
  • Confusion between IBD and IBS
  • Food sensitivity and allergy
  • Restriction diets
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2
Q

What part of the duct doe functional GI disease affect?

A

Every part of the gut

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3
Q

Give examples of upper GI functional GI diseases.

A
  • Reflux
  • Functional dyspepsia
  • Nausea vomiting syndromes
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4
Q

Give an example of an intestinal functional GI disease.

A

IBS

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5
Q

Give an example of a biliary functional GI disease.

A

Sphincter of Oddi dysfunction

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6
Q

What is the aetiology of functional GI disease.

A

Multifactorial

  • Motility
  • Gut hormones
  • Gut microbiome
  • Diet
  • Increased visceral sensation
  • Psychological factors
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7
Q

How does functional GI disease appear on investigations and examination?

A

Normal

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8
Q

What is important to establish during the history of functional GI disease?

A

Time line

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9
Q

What other assessments should be carried out during physical examination of functional GI disease?

A
  • Nutritional assessment

- Mental state assessment

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10
Q

What psychological problems can be caused by GI disease?

A
  • Conditioning
  • Nausea and vomiting
  • Loss of appetite
  • Weight loss
  • Sexual problems
  • Stress
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11
Q

What psychological problems can present ass GI disease?

A
  • Stress
  • Anxiety
  • Depression
  • Somatisation
  • Eating disorders
  • Mental state examination
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12
Q

Slide 11

A

Slide 11

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13
Q

What investigations should be performed in acute GI disease?

A
  • FBC
  • Biochemical profile
  • Pregnancy test
  • Urinalysis/culture
  • H pylori status
  • Erect CXR
  • AXR
  • USS
  • Endoscopy?
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14
Q

How is nutritional risk assessed?

A

MUST

  • BMI
  • Weight loss
  • Have you eaten anything for 5 days?
  • Score> 2 significant risk of malnutrition
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15
Q

What simple measures can be put in place for malnutrition?

A
  • IV fluids
  • Pabrinex (standard multivitamin IV preparation)
  • Dietetic review in morning
  • NG tube
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16
Q

What does refeeding syndrome cause?

A

Shift in electrolytes which can result in cardiac arrest

17
Q

Adapted starvation

A
  • Reduced intake of carbohydrate

- Reduced secretion of insulin

18
Q

What is happening in the body of someone who may experience refeeding syndrome?

A
  • Adapted starvation
  • Main sources of energy are fat and protein therefore reduced intracellular phosphate and extra cellular phosphate may be normal
  • Low expenditure of energy (lethargy, lack of physical activity)
  • Atrophic gut, heart, muscles
  • Low micronutrient reserves
19
Q

What does refeeding with carbohydrates result in?

A
  • Rapid rise in insulin
  • Rapid generation of ATP
  • Phosphate moves into cells
  • Hypophosphatemia rapidly develops
20
Q

Criteria for determining people at high risk of developing refeeding syndrome. Patient has 1 or more of the following…

A
  • BMI less than 16
  • Unintentional weight loss greater than 15% within the last 3-6 months
  • Little or no nutritional intake for more than 10 days
  • Low levels of potassium, phosphate or magnesium prior toe feeding
21
Q

Criteria for determining people at high risk of developing refeeding problems. Patient has 2 or more of the following…

A
  • BMI less than 18.5
  • 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
22
Q

What is the treatment for someone who may experience refeeding syndrome?

A

Start slow

  • Correct fluid depletion
  • Thiamine at least 30 mins before feeding starts
  • Feed @ 5-10kcal/kg over 24 hrs
  • Gradual increase to requirement over 1 week
23
Q

When should electrolytes be replaced?

A
  • Phosphate <0.3mmol/l
  • K<2.5mmol/l
  • Mg<0.5mmol/l
  • Thiamine
24
Q

Give 3 examples of “conditions” that can produce disordered eating.

A
  • Crohns
  • Coeliac disease
  • Missing false teeth
25
Q

What are the characteristics of a binge eating disorder?

A
  • Binges, purging
  • But fail to compensate
  • Gain weight
26
Q

What are the characteristics of bulimia nervosa?

A
  • Restriction
  • Binges
  • Purging
  • Normal or near normal weight
27
Q

What are the characteristics of anorexia nervosa?

A
  • Restriction (significant weight loss)
  • Obsessive fear of gaining weight (perfectionism, significantly impaired decision making)
  • Body dysmorphia (distorted self image)
  • Over exercising
  • Amenorrhoea
28
Q

Other than eating control what other behaviours are often present in eating disorders?

A
  • Self starvation
  • Self-induced vomiting
  • Compulsive activity and exercise
  • Use of laxatives
  • Diet pills
  • Herbal medicines
  • Deliberate exposure to the cold
29
Q

What are the general principles of treatment in eating disorders?

A

Firm and consistent team approach

  • Dietitian, ward nurses etc.
  • Decide on management recommendations as a team
  • Avoid arguments at the bedside
  • May need NG feeding
  • Watch for refeeding syndrome
30
Q

What specialist help should be sought for eating disorders?

A
  • Liaison psychiatrist
  • Specialist in eating disorders
  • Externalisation
  • Keep the patient safe
31
Q

What are the management principles for functional GI disease?

A
  • Listen to patient carefully
  • Treat symptoms seriously
  • Reach a firm diagnosis
  • Explain functional disease
  • Manage the underlying disease

Systems: Alimentary AB (37 decks)

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