Psychological Aspects of GI Disease/ Eating Disorders Flashcards
What psychological influences are there on organic acute disease?
- Patients perception
- Cancer fears
- Confusion between IBD and IBS
- Food sensitivity and allergy
- Restriction diets
What part of the duct doe functional GI disease affect?
Every part of the gut
Give examples of upper GI functional GI diseases.
- Reflux
- Functional dyspepsia
- Nausea vomiting syndromes
Give an example of an intestinal functional GI disease.
IBS
Give an example of a biliary functional GI disease.
Sphincter of Oddi dysfunction
What is the aetiology of functional GI disease.
Multifactorial
- Motility
- Gut hormones
- Gut microbiome
- Diet
- Increased visceral sensation
- Psychological factors
How does functional GI disease appear on investigations and examination?
Normal
What is important to establish during the history of functional GI disease?
Time line
What other assessments should be carried out during physical examination of functional GI disease?
- Nutritional assessment
- Mental state assessment
What psychological problems can be caused by GI disease?
- Conditioning
- Nausea and vomiting
- Loss of appetite
- Weight loss
- Sexual problems
- Stress
What psychological problems can present ass GI disease?
- Stress
- Anxiety
- Depression
- Somatisation
- Eating disorders
- Mental state examination
Slide 11
Slide 11
What investigations should be performed in acute GI disease?
- FBC
- Biochemical profile
- Pregnancy test
- Urinalysis/culture
- H pylori status
- Erect CXR
- AXR
- USS
- Endoscopy?
How is nutritional risk assessed?
MUST
- BMI
- Weight loss
- Have you eaten anything for 5 days?
- Score> 2 significant risk of malnutrition
What simple measures can be put in place for malnutrition?
- IV fluids
- Pabrinex (standard multivitamin IV preparation)
- Dietetic review in morning
- NG tube
What does refeeding syndrome cause?
Shift in electrolytes which can result in cardiac arrest
Adapted starvation
- Reduced intake of carbohydrate
- Reduced secretion of insulin
What is happening in the body of someone who may experience refeeding syndrome?
- 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
What does refeeding with carbohydrates result in?
- Rapid rise in insulin
- Rapid generation of ATP
- Phosphate moves into cells
- Hypophosphatemia rapidly develops
Criteria for determining people at high risk of developing refeeding syndrome. Patient has 1 or more of the following…
- 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
Criteria for determining people at high risk of developing refeeding problems. Patient has 2 or more of the following…
- 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
What is the treatment for someone who may experience refeeding syndrome?
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
When should electrolytes be replaced?
- Phosphate <0.3mmol/l
- K<2.5mmol/l
- Mg<0.5mmol/l
- Thiamine
Give 3 examples of “conditions” that can produce disordered eating.
- Crohns
- Coeliac disease
- Missing false teeth
What are the characteristics of a binge eating disorder?
- Binges, purging
- But fail to compensate
- Gain weight
What are the characteristics of bulimia nervosa?
- Restriction
- Binges
- Purging
- Normal or near normal weight
What are the characteristics of anorexia nervosa?
- Restriction (significant weight loss)
- Obsessive fear of gaining weight (perfectionism, significantly impaired decision making)
- Body dysmorphia (distorted self image)
- Over exercising
- Amenorrhoea
Other than eating control what other behaviours are often present in eating disorders?
- 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 of treatment in eating disorders?
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
What specialist help should be sought for eating disorders?
- Liaison psychiatrist
- Specialist in eating disorders
- Externalisation
- Keep the patient safe
What are the management principles for functional GI disease?
- Listen to patient carefully
- Treat symptoms seriously
- Reach a firm diagnosis
- Explain functional disease
- Manage the underlying disease
