Week 4.3 - Functional GI Disorders Flashcards
What is non-ulcer dyspepsia?
- ulcer like pain in absence of stomach ulcer.
- symptoms overlap with reflux, delayed gastric emptying and IBS
How do you diagnose non-ulcer dyspepsia?
history and examination. family history of coeliac or gastric cancer. h.pylori.
- if all negative, give PPI for symptoms.
- if h.pylori, treat
- if alarm symptoms, endoscopy
how do you diagnose vomiting and nausea?
history - length after eating, drug history, pregnancy, alcohol, migraine, cyclical vomiting syndrome (kids)
What does the length of time after eating regarding vomiting tell us?
- immediately is psychogenic
- 1hr is pyloric obstruction/motility disorder
- 12hrs is distal issue maybe obstruction
What are 2 functional disorders of the lower GI tract?
IBS and slow transit constipation (without IBS pain)
How do we assess patients who turn up?
history - assess change in their personal normal gut function - frequency (bristol stool chart), consistency, blood, mucus? how long? incontinence?
- ask about antibiotic use, family history of gastric cancer/coeliac
- ask about alarm symptoms
What investigations do we do for patients appearing with functional GI disorder?
physical exam:
- systemic disease
- abdominal exam
- rectal exam (tumour?)
What are causes of constipation?
systemic, functional, organic or neurological
What are diseases causing constipation and their types?
- systemic - diabetes, hypothyroidism, hypercalcaemia
- functional -megacolon, idiopathic, depression, psychosis, institutionalised
- organic - strictures, tumours, anal fissure, proctitis, diverticulitis
- neurological - MS, stroke, parkinsons, autonomic neuropathy
What is IBS defined by?
abdominal pain with either altered bowel habit, abdominal bloating, or both. typically chronic relapsing remitting
Which criteria are used to diagnose IBS?
ROME or NICE criteria
What is the pain like in IBS?
vague, bloating, burning, sharp. similar to cramps. usually relieved by releasing bowels. pain rarely at night. similar to inflating balloon in rectum
What are types of IBS?
IBS-D - diarrhoea dominant
IBS-C - constipation dominant
IBS-M - mix
What is included in a general examination for IBS? (10)
- bloods,
- FBC - anaemia, wbc+platelets suggest inflammation
- u&E electrolytes
- LFT’s
- CRP (inflammation)
- calprotectin
- stool culture
- FIT
- rectal exam
- colonoscopy if necassary
What is management and treatment of IBS?
- give definite diagnosis,
- reassure,
- make sure they look out for alarm symptoms,
- watch diet and possibly do FODMAPS diet.
what is calprotectin?
inflammatory protein that gets across gut wall in inflamed mucosa. indicated IBD rather than IBS
What treatments do we give to IBS patients for pain?
- for pain, antidepressants regarding diarrhoea and bloating (different types).
- peppermint supplement colpermin
What treatments do we give to IBS patients for constipation, diarrhoea and bloating?
- for bloating, laxatives, avoid bulking agents,
- for constipation, osmotic laxative. if resistant give linaclotide
- diarrhoea, anti-motility agents. loperamide long term
How do you treat psychological factors regarding IBS?
hypnotherapy effective. also CBT for abdominal pain and to cope better with symptoms
What is thought to cause IBS?
- peristaltic issues
- visceral hypersitivity
- loud messages to brain regarding hunger and defecation urges
