Week 4/5 - G - Psychiatry&G.I - Globus, Functional dysphagia, Irritable bowel syndrome, Anorexia nervosa/bulimia/binge eating Flashcards
What is a functional disorder?
A functional disorder is a medical condition that impairs normal functioning of bodily processes that remains largely undetected under examination, dissection or even under a microscope. At the exterior, there is no appearance of abnormality. Generally, the mechanism that causes a functional disorder is unknown, poorly understood - the brain and nerves are often believed to be involved
Lets start at the top of the GI tract and work down to discuss common psychiatric and GI tract conditions What is globus sensation?
Globus sensation is the sensation of a lump in the throat, when not swallowing food and with no primary swallowing difficulties
The cause of globus sensation is unclear and there are many different thoughts as to what cause it What are some associated symptoms with globus sensation?
Globus sensation is a term used to describe the feeling of a lump in the throat where no true lump exists. It is extremely common and may be associated with hoarseness of voice and also decreased mood
What are some causes of globus sensation?
Foreign body in the throat Reflux Inflammation of the pharynx Cancers Neurological conditions Treatment is usually reassurance * If evidence of acid reflux, maybe give antacids * If hoarsness, maybe speech and language therapist
What is globus hystericus? (also simply known as globus) How is it diagnosed?
Globus hystericus (or globus) is the feeling of a lump in the throat oftenly experienced with an intence emotional experience ie anxiety, or being upset, stress Globus hystericus is a diagnosis of exclusion - ie no other pathology for the sensation of the lump in the throat was able to be found
What is functional dysphagia? How is it diagnosed?
Functional dysphagia is the sensation of solid (or liquid) food ‘sticking’ on the way down the oseophagus Again, the diagnosis of ‘functional dysphagia’ (as opposed to the symptom of dysphagia) is a diagnosis of exclusion.
As functional dysphaga is a diagnosis of exlcusion (as are a lot of the functional disorders), what tests would be carried out for the routine investigation of dyshagia?
The doctor will usually first test endoscopy for the presence of structural injury or disease. When nothing is found, manometry and barium swallow, Manometry is a test that measures pressure in the esophagus, is next performed looking for evidence of achalasia and other disorders that may affect the movement of foods or liquid through the esophagus. In cases of functional dysphagia, 24-hour pH monitoring is generally reserved for individuals where the history is particularly suggestive of reflux disease, such as persistent heartburn.
What does the management of functional dysphagia involve?
REASSURANCE * Dietary adjustments including foods that trigger dysphagia * Advising careful chewing of food * Avoiding fizzy drinks
IRRITABLE BOWEL SYNDROME What is irritable bowel syndrome? What is thought to be potential causes?
Irritabel bowel syndrome is a mixed group of abdominal symptoms for which no organic cause can be found - most are probably due to * disorders of intestinal motility, * dysregulation of the brain gut axis - greater stress reactivity and modulation/perception of afferent signals from ENS * or microbial dysbiosis (microbial imbalance)
What is the Rome IV criteria for diagnosing irritable bowel syndrome?
Recurrent abdominal pain or discomfort at least 1 day per week for the last 3 months, with symptom onset at least 6 months prior to diagnosis * Associated with 2 or more of the following * Improvement with defecation * Onset associated with a change in frequency of stool * Onset associated with a change in form (appearance) of stool
What are other features that are associated with IBS?
Features such as * Urgency * Incomplete evacuation * Abdominal bloating / distension * Mucus PR * Worsening of symptoms after food * Often exacerbated by stress, menstruation or gastroenteritis
Who is IBS more common in?
More common in females and tend to be aged <50 years at onset
What are some symptoms that would make you consider a diagnosis other than IBS?
Red flag features should be enquired about: rectal bleeding unexplained/unintentional weight loss family history of bowel or ovarian cancer onset after 60 years of age
What are suggested investigations used in the diagnosis of IBS? (these are usually carried out to rule out other potential diagnosis)
Suggested primary care investigations are: * full blood count - looks for anaemia (malabsorption symptoms) * ESR/CRP - looks for inflammation eg UC or Crohn’s * coeliac disease screen (IgA tissue transglutaminase antibodies and total IgA serum level)) * Faceal calprotectin All should be normal
Treatment of IBS should focus on controlling the symptoms * Initially lifestyle / dietary measures, * then pharmacotherapy or cogntiive therapy is used if required What are the dietary measures often used in the treatment of IBS?
If constipation - increase fibre and water intake If diarrhoea - decrease fibre intake Avoid caffeine, Avoid pulses, onion garlic, mushrooms (these can ferment, causing gas, worsening the bloating)
What is the diet known as that is sometimes used by patients with IBS if not-responding to initially dietary steps? What are the three steps in this diet? It is thought to limit foods that have been shown to aggravate the gut and cause Irritable Bowel Syndrome (IBS) symptoms like intestinal bloating, gas and pain.
This is the low FODMAP diet FODMPAP elimination - temporary restriction (2weeks to max of 8 weeks) FODMAP reintroduction - identify trigger foods FODMAP customization - people know which food groups they can have and which they cannot
What are the different signs of Bulimia nervosa?
Oeseophagitis Gastric dilatation with gastric rupture Metabolic abnormalities eg hypokalaemia, hyponatraemia - Can have heart conduction abnormalities Erosion of dental enamel due to acid refluex Calluses on the bank of hands -Ruseel’s sign -tooth marks during induction of vomiting
