Psychological aspects of GI disease - eating disorders

Question 1

Name some psychological problems presenting as GI disease

Answer 1

Stress
anxiety
depression
eating disorders

Question 2

What is a functional GI disease? Give examples

Answer 2

conditions where structure of the gut is normal but it doesn’t function normally - investigations + physical examinations are normal

more common in younger people

Upper GI
Reflux
Functional dyspepsia – indigestion without reflux
Nausea vomiting syndromes

Intestinal
IBS

Biliary disease
Sphincter of Oddi Dysfunction – Difficult to diagnose and treat

Question 3

Describe the term ‘visceral sensitivity’

Answer 3

different people are more/less in tune with pain from their gut

different perception of internal pain

can vary in an individual over time - anxiety can heighten gut sensitivity

Question 4

What are some psychological problems caused by GI disease?

Answer 4

Conditioning - associating pain with symptoms of disease etc

Nausea and vomiting

Loss of appetite - Weight loss

Diarrhoea

Sexual problems

“Stress”

Question 5

Which psychological problems present as GI disease? (5)

Answer 5

Stress
Anxiety
Depression
Somatisation (tendency to experience psychological distress in the form of somatic symptoms)
Eating disorders

Question 6

Which drugs can upset the gut?

Answer 6

Opiates - prescribed, non-prescribed, illegal

Amphetamines

Cocaine

anticholinergics

antidepressants

Question 7

What is the diagnosis likely to be for people who vomit at sight or smell of something within 20 mins of eating?

Answer 7

more likely functional GI disease

Question 8

What is the diagnosis likely to be for people who vomit within several hours of eating

Answer 8

gastric outlet obstruction

Question 9

What is refeeding syndrome?

Answer 9

after period of starvation body becomes adapted to reduced intake. It can be risky to flood body with nutrients again. Low intracellular phosphate levels

when you refeed with carbohydrate you get:-

Rapid rise in insulin
Rapid generation of ATP
Phosphate moves into cells to make ATP
Hypophosphataemia rapidly develops results in muscle weakness

Question 10

Patients at high risk of developing refeeding problems?

Answer 10

have to consider BMI, weight changes, nutritional intake and phosphate levels

Question 11

Refeeding treatment

Answer 11

Need to give thiamine 30 mins before feeding starts - if you run out of thiamine can cause long term brain damage

start at low calorie level = 5-10 kcal/Kg over 24 hours

Question 12

3 main types of eating disorders

Answer 12

Binge eating disorder
Bulimia Nervosa
Anorexia Nervosa

Question 13

Binge Eating disorder

Answer 13

Binges, purging (vomit so lose calories)

But fail to compensate (still eating a lot)

Gain weight

Question 14

Bulimia Nervosa

Answer 14

Restriction/ Binges – alternate between the 2

Purging

Normal or near normal weight.

Compensation and over eating match so maintain weight

Question 15

Anorexia nervosa

Answer 15

Restriction
- Significant weight loss

Obsessive fear of gaining weight

• Perfectionism
• Significantly impaired decision making (SIDMA)

Body dysmorphia
Distorted self image

Over exercising

Amenorrhoea