Week 4.3 - Functional GI Disorders

Question 1

What is non-ulcer dyspepsia?

Answer 1

• ulcer like pain in absence of stomach ulcer.
• symptoms overlap with reflux, delayed gastric emptying and IBS

Question 2

How do you diagnose non-ulcer dyspepsia?

Answer 2

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

Question 3

how do you diagnose vomiting and nausea?

Answer 3

history - length after eating, drug history, pregnancy, alcohol, migraine, cyclical vomiting syndrome (kids)

Question 4

What does the length of time after eating regarding vomiting tell us?

Answer 4

• immediately is psychogenic
• 1hr is pyloric obstruction/motility disorder
• 12hrs is distal issue maybe obstruction

Question 5

What are 2 functional disorders of the lower GI tract?

Answer 5

IBS and slow transit constipation (without IBS pain)

Question 6

How do we assess patients who turn up?

Answer 6

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

Question 7

What investigations do we do for patients appearing with functional GI disorder?

Answer 7

physical exam:
- systemic disease
- abdominal exam
- rectal exam (tumour?)

Question 8

What are causes of constipation?

Answer 8

systemic, functional, organic or neurological

Question 9

What are diseases causing constipation and their types?

Answer 9

• systemic - diabetes, hypothyroidism, hypercalcaemia
• functional -megacolon, idiopathic, depression, psychosis, institutionalised
• organic - strictures, tumours, anal fissure, proctitis, diverticulitis
• neurological - MS, stroke, parkinsons, autonomic neuropathy

Question 10

What is IBS defined by?

Answer 10

abdominal pain with either altered bowel habit, abdominal bloating, or both. typically chronic relapsing remitting

Question 11

Which criteria are used to diagnose IBS?

Answer 11

ROME or NICE criteria

Question 12

What is the pain like in IBS?

Answer 12

vague, bloating, burning, sharp. similar to cramps. usually relieved by releasing bowels. pain rarely at night. similar to inflating balloon in rectum

Question 13

What are types of IBS?

Answer 13

IBS-D - diarrhoea dominant
IBS-C - constipation dominant
IBS-M - mix

Question 14

What is included in a general examination for IBS? (10)

Answer 14

• bloods,
• FBC - anaemia, wbc+platelets suggest inflammation
• u&E electrolytes
• LFT’s
• CRP (inflammation)
• calprotectin
• stool culture
• FIT
• rectal exam
• colonoscopy if necassary

Question 15

What is management and treatment of IBS?

Answer 15

• give definite diagnosis,
• reassure,
• make sure they look out for alarm symptoms,
• watch diet and possibly do FODMAPS diet.

Question 16

what is calprotectin?

Answer 16

inflammatory protein that gets across gut wall in inflamed mucosa. indicated IBD rather than IBS

Question 17

What treatments do we give to IBS patients for pain?

Answer 17

• for pain, antidepressants regarding diarrhoea and bloating (different types).
• peppermint supplement colpermin

Question 18

What treatments do we give to IBS patients for constipation, diarrhoea and bloating?

Answer 18

• for bloating, laxatives, avoid bulking agents,
• for constipation, osmotic laxative. if resistant give linaclotide
• diarrhoea, anti-motility agents. loperamide long term

Question 19

How do you treat psychological factors regarding IBS?

Answer 19

hypnotherapy effective. also CBT for abdominal pain and to cope better with symptoms

Question 20

What is thought to cause IBS?

Answer 20

• peristaltic issues
• visceral hypersitivity
• loud messages to brain regarding hunger and defecation urges