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Repair And Regeneration > Week 9 Part 2 > Flashcards

Week 9 Part 2 Flashcards

1
Q

What does itis generally mean?

A

Inflammation of the colon

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2
Q

What is IBS?

A

Clinical diagnosis based on typical symptoms - ABC of symptoms

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3
Q

1950

A

It was called nervous colitis

Definition has changed considerably over the years

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4
Q

1960

A

Mucous colitis
Absence of objective biomarker
Symptom based diagnosis

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5
Q

1970

A

Spastic colon

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6
Q

1980

A

Irritable bowel syndrome

systematised by multi-national Rome comittee - 4th iteration

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7
Q

What is the Manning criteria?

A

Abdominal pain was in someway associated with bowel movements

Pain relieved by defaecation

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8
Q

What did Rome criteria suggest?

A

Recurrent abdominal pain on weekly basis

Change in frequency/form of stool

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9
Q

What is the red flag symptoms?

A

Rectal bleeding
Weight loss
Recent antibiotic use
Nocturnal symptoms

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10
Q

What are the criteria based diagnosis of IBS?

A

Symptoms present for more than 6 months
Frequent consultation for non-gastrointestinal symptoms
Previous medical unexplained symptoms
Patient reports that stress aggravates symptoms

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11
Q

What are alarm feature in IBS?

A 
Age > 50 years
Short history of symptoms 
Documented weight loss 
Nocturnal symptoms
Male sex 
Family history of colon cancer 
Anaemia 
Recital bleeding 
Recent antibiotic use
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12
Q

What does IBS cover?

A

A lot of different symptoms

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13
Q

IBS mixed

A

Float back and forth between diarrhoea and constipation

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14
Q

IBS with constipation

A

> 25% hard stools

<25% loose stools

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15
Q

IBS mixed

A

Both hard and loose stools

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16
Q

IBS with diarrhoea

A

> 25% loose stools

< 25% hard stools

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17
Q

Epidemiology of IBS in US and Europe

A

10-15%

Similar to South America

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18
Q

Epidemiology in China of IBS?

A

23%

1 in 4 people to have IBS

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19
Q

Gender difference in terms of IBS

A

3 females to 1 male in the UK/North America

Reflects the degree of cultural differences between groups

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20
Q

What is the main predictor of IBS?

A

Abdominal pain

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21
Q

How much percentage does IBS count for in all GP consultation?

A

3%

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22
Q

What does predictors do?

A

Move patients from primary care to secondary care

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23
Q

What are patients worried about?

A

Abdominal pain
Changes in bowel habits
cancer

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24
Q

What makes IBS symptoms worse?

A

Stress

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25
Q

What does predictors do?

A

Move patients from primary care to secondary care

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26
Q

What are patients worried about?

A

Abdominal pain
Changes in bowel habits
cancer

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27
Q

What makes IBS symptoms worse?

A

Stress

28
Q

Why is IBS a common disorder?

A

4 new patients of IBS every year

29
Q

What is presenteeism?

A

Working while sick - not doing anything productive
Productivity loss
Poor health
Exhaustion and work place epidemics

30
Q

What is the cost of patients in the US?

A

Over 5000 dollars per annum

31
Q

What does SFI36 measure ?

A

Instrument used for evaluating health-related QoL

32
Q

What are the different aspects it measures?

A 
Physical functioning 
Physical limitation 
Bodily pain
Well being 
Emotional 
General health
33
Q

IBS

A

Costs a lot

Significant reduction in people’s quality of life

34
Q

What is the prevalence of IBS?

A

10-20%

35
Q

What are different components of abdominal pain?

A

Psychosocial abnormalities
Motility abnormalities
Sensory abnormalities
CNS processing abnormalities

36
Q

What is the Brain Gut Axis?

A

Bi-directional communication system from gut to CNS

37
Q

What is the Enteric Nervous System?

A

Little Brian

38
Q

What is the Enteric Nervous System?

A

Little Brain

Brain in the GIT

39
Q

What is ENS composed of?

A

2 neuronal plexus

Sub-mucosal and mucosal plexi

40
Q

What does the 2 neuronal plexus control?

A

Motility
Secretion
Neurohormonal activation within the gut

41
Q

What are the 2 pathways that information goes back up to the brain?

A

Spinal pathways

Vagal pathways

42
Q

What is spinal pathways?

A

Roles in perception of the internal state

Pain and inhibition of digestive function

43
Q

What is vagal pathway?

A

Physiological sensation
Hunger, satiety etc
Reflex control
Behaviour

44
Q

What are 3 main pathways of ascending?

A

Spinomesencephalic
Spinoreticular
Spinothalamic

45
Q

Geography of pain

A

Posterior Insula
Thalamus
Primary sensory area

46
Q

Emotional/affective component of pain

A

Pain makes us feel
Amygdala, anterior Insula, ACC
Pain forms memories

47
Q

Descending pathway

A

Largely mediated in ACC via periaacquctal grey in the medulla
3 separate pathsways after their neurotransmitters - Opiodergic, Noradrenergic and Serotonergic

48
Q

What does CNS exert influence on?

A

Motility
Secretion
Immune function

49
Q

What is the Brain gut axis vital for?

A

Regulation of food intake
Digestion
Sensation
Control of motility

50
Q

What happens if there is any disruption at any level of brain gut axis?

A

Profound changes in perception in the internal state

51
Q

What is visceral hypersensitivity?

A

Changes in gut motility

52
Q

Why do patients with IBS get chronic abdominal pain?

A

Disturbance of brain gut axis at any level

Change from level of gut wall, spinal dorsal horn, spinal cord to anywhere in the CNS

53
Q

What is TRPV1 sensitive to?

A

Capsaicin

54
Q

What does all IBS patients have?

A

Elevated TRPV1 fibres in the rectum

55
Q

What is post-infectious IBS?

A

When IBS occurs after what appears to be a bout of gastroenteritis

56
Q

Post infectious IBS has been described following what infections?

A

Campylobacter
Salmonella
Shigella

57
Q

What are the risk factors for PI-IBS?

A

The duration and severity of initial illness
Features in the infected person such as psychological factors m, gender and age
The capability of bacteria to produce a toxin

58
Q

What are the physiological mechanisms in IBS?

A 
Central nervous system 
Stress responsive systems 
Psychological factors 
Genetic factors 
Microbiota
59
Q

In IBS what is there a considerable overlap with?

A

Psychological disorders

60
Q

What are the functional neuroimaging techniques ?

A

Cortical evoked potentials (CEP)
Magnetoencephalograpy (MEG)
Position Emission Tomography
Functional Magnetic Resonance Imaging

61
Q

Central Structural Abnormalities in IBS

A

Thinning in the anterior mid-cingulate and insular cortex in IBS

62
Q

What did meta-analysis of central structures show greater engagement with?

A

Emotional arousal

Endogenous pain modulation

63
Q

What are the major components of stress responsive system?

A

ANS
HPA axis

Link external environment with internal milieu

64
Q

What can psychological factors do?

A

Aggravate or induce symptoms

65
Q

What do IBS patients with history of abuse have?

A

Lower sensory thresholds
Lower defaecatory urge thresholds
Greater tendency to report pain

66
Q

What are the 3 phyla within human gut?

A

Firmicutes
Bacteroidetes
Actinobacteria

Repair And Regeneration (16 decks)

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