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EXMD4743 > Wk2 - Polycystic Ovarian Syndrome (PCOS) and GI > Flashcards

Wk2 - Polycystic Ovarian Syndrome (PCOS) and GI Flashcards

1
Q

What is PCOS?

A
  • one of most common hormonal problems in women during reproductive years

Polycystic = many cysts
- partially formed follicles on ovaries - each contain egg - rarely growth to maturity/be fertilised
- up to 1/3 women may have PCOS ovaries seen on ultrasound

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2
Q

How is PCOS Dx?

A
  1. irregular/absent periods
  2. acne, excess facial/body hair, scalp hair loss, high circulating androgen levels
  3. many small cysts on ovaries
  • don’t need ultrasound if you have 1. and 2.

For women aged <20y, ultrasounds not recommended

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3
Q

Please list the PCOS Sx?

A

Central obesity
- lean PCO ~30%

Irregular menstrual cycle
- periods may be less or more frequent due ot less frequent ovulation

Amenorrhoea
- some don’t menstruate - some cases… for many years

Excessive facial/body hair
Acne
Scalp hair loss
Reduced fertility - related to less frequent/absent ovulation
Sleep apnoea
Mental Health

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4
Q

What are the long-term health risks of PCOS?

A

~15y: clincial hyperandrogenism and Oligo-Anovulation

~25-30y: infertility, hyperandrogenism, pregnancy complication

~45y: hyperandrogenism, glucose intolerance

~55y: CV event, T2DM, endometrial cancer

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5
Q

What is PCOS associated with?

A
  • ~80% insulin resistance, risk of T2DM, esp. if overweight
  • CVD
  • pregnancy complications
  • blood lipid abnormalities
  • endometrial cancer
  • anxiety/depression
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6
Q

Why does PCOS increase risk for diabetes?

A

PCOS increases androgen levels = visceral adipose accumulation leading to increased inflammatory cytokines = insulin resistance and diabetes

  • too much insulin = inflammation causing weight gain, leading to T2DM and heart disease
  • high insulin is Sx of PCOS - impairs ovulation and causes ovaries to make excess testosterone
  • oral contraceptives -vely interfere with glycaemic control and insulin resistance
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7
Q

What is the prevalence of insulin resistance in obese and lean PCOS?

A

70-95% obese PCOS
30-75% lean PCOS

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8
Q

How is PCOS managed?

A

long-term management required
Includes:
* lifestyle mods - increase PA and healthy diet
* weight reduction - 5-10% loss provide significant health benefits
* med Tx - hormones or meds
* psychology - improve emotional health (mood, self confidence or body image)

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9
Q

What medications are used to manage PCOS?

A

Birth Control - regulate menstrual cycle, reduce excess hair growth, acne and prevent thickening of womb lining

Spirolactone - blocks hormones such as testosterone to reduce hair growth/scalp loss

Insulin sensitising meds (metformin) - improve insulin resistance, regulate menstrual cycles, ovulation and fertility, assist weight loss

Infertility meds - clomiphene citrate/aromatase inhibitors - stimulate ovulation

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10
Q

How is PCOS developed/caused?

A

Cause generally unknown

Genetics, hormones, lifestyle

Hypothalamic pituitary axis (HPA) imbalance

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11
Q

What is the prevalence of PCOS?

A

8-13% women of reproductive age
~50% cases unDx

Affects 1 in 10 women

50% with PCOS develop T2DM/pre-diabetes before 40y

4.3bill cost

3x increased risk of PCOS developing endometrial cancer

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12
Q

What are the risk factors of PCOS?

A

Family Hx - mum, aunt, sis with PCOS = 50% more likely

Race - more common in Asians, Aboriginal/TSI and African backgrounds

Others risks dependent on AGE…
* before birth (small gestational age)
*childhoold/prepuberty - early onset obesity, increased androgens during puberty onset, premature/pubarche, hyperinsulinaemai
* adolescence - obese, irregular menstrual/ olioamenorrhoea, polycystic ovarian morphology, high androgen levels, unwanted hair growth

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13
Q

What are the potential benefits of Ex?

A
  • insulin resistance
  • ovulation/reproductive health
  • conception
  • hirsutism/acne
  • cardiometabolic risk
  • mental health
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14
Q

What evidence is there of the potential benefit of Ex for PCOS?

A
  • 3M of supervised Ex improved insulin resistance despite weight maintenance
  • unlikely Ex elicits meaningful changes in HOMA-IR
  • benefits women with higher insulin resistance more
  • Ex w/wo diet = resumption of ovulation in overweight women by resetting HPA
  • Ex training improve rates (2x) clinical pregnancy and live births
  • equally effective as current drug Tx
  • Ex decreases hyperandrogenism - limited studies on hirsutism and acne
  • Improve CRF and waist circumference
  • SBP, lipid profiles unchanged
  • improve QoL, reduces Sx of depression/anxiety
    *RT effective = improves BGL, testosterone, sex hormone-binding globulin, strength, FFM
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15
Q

A patient asks “How will Ex benefit my health?”, what do you say?

A
  • increases occurrence of ovulation/conception
  • decreases cardiometabolic risk
  • improves mental health
  • decreases risk of diabetes
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16
Q

Please provide some Ex recommendations?

A

Lifestyle! increase PA and encourage healthy diet

  • encourage/advise prevention of weight gain/modest weight-loss, prevention of weight-regain
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17
Q

What would you tell someone with PCOS on whether training will improve chance of pregnancy?

A
  • lead to resumption in ovulation and increased rate of clinical pregnancy and live births
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18
Q

Provide a summary for PCOS.

A
  • common endocrine condition affecting up to 18% reproductive-aged women
  • associated with adverse reproductive, metabolic and psychological feature
  • benefits cardiometabolic comorbidities
  • evidence accumulating for Ex benefits on reproductive issues
  • PA guidelines
19
Q

What is the Gut-Brain Axis?

A

Bidirectional link between CNS and ENS
* involves in/direct pathways between cognitive/emotional centres with GI functions
* complex crosstalk between endocrine (HPA), immune (cytokine/chemokines) and ANS
*neuro-immuno-endocrine mediators of GBA allow brain to influence GI function (immune/epithelial cells, enteric neurons, smooth muscle cells)
* Cells of GI under influence of gut microbiota (important in GBA)

20
Q

Define gut microbiota.

A

Microbiome = all microorganisms in or on host and their genetic material
* approx 150x greater than human genome
* in gut, approx 10^14 microorganisms - ~10fold more cells than human body
* disruptions = alergies, autoimmune diseases, metabolic disorder nad neurpsychiatric disorders

Regular PA = modify intestinal microbiome, improve diversity and enhance no. of beneficial bacteria

21
Q

Provide some GI conditions.

A

STRUCTURAL
* IBD - ulcerative colitis // Crohn’s disease
* Gatroesophageal Reflux Disease (GORD)

FUNCTIONAL
* IBS // functional dyspepsia

  • Coeliac Disease
  • diverticulitis
  • Chronic Pancreatitis
    *Peptic Ulcer Disease
  • Lactose Intolerance
  • Eosinophilic GI Disorder (EGID)
22
Q

What is the difference between structural and functional GI conditions?

A

Structural:
Sx include nausea, abdominal pain, change in bowel habits with ABNORMAL physiology of 1 or more sections of GI tract
e.g. GORD, IBD, haemorrhoids, cancer

Functional:
Sx include nausea, abdombinal pain, change in bowel habits with NORMAL presentation of GI tract.
e.g. IBS, functional dyspepsia/dysphasia

23
Q

What is IBD?

A

Umbrella term for autoimmune disorder that leads to chronic inflammation of digestive tract.
2 main IBDs:
* ulcerative colitis - causes long-lasting inflammation and ulcers in innermost lining of large intestine and rectum
* Crohn’s Disease - inflammation of lining of digestive tract, often spread deep into affected tissues

24
Q

What happens when you have IBD?

A
  • involve severe diarrhea, abdominal pain, fatigue and weight loss
  • Dx in young adulthood ~25y, life-long disease
  • lead to comorbidities - rhumatoid arthritis, dermatological inflammation (rashes, eye disease) and lung conditions - emphysema

No known cause!

25
Q

What is GORD?

A
  • occurs when stomach acid frequently flows back into esophagus
  • acid reflux irritates esophagus lining
  • mild acid reflux occuring at least 2x/wk. Mod-sev = 1x/wk
  • can be managed with lifestyle and OTC meds
  • some require strong meds or surgery
26
Q

What is ROME?

A

Use to categorise conditions.
Adults: 8 domains and 22 sub-domains

5 most common subdomains: IBS, functional dyspepsia, functional constipation, function diarrhea & functional bloating/distention

27
Q

What is IBS?

A

AKA nervous stomach, irritable colon
* muscles of large intestine contract more often than normal
* manage with diet, lifestyle and stress
* abdominal pain relieved with bowel movement
* more-sev Sx Tx with meds and couselling
* IBS doesn’t change bowel tissue or increase risk of colorectal cancer

28
Q

Whatis Functional Dyspepsia?

A
  • unexplained fullness after meals, unable to finish normal-sized meal, epigastric pain/burning
  • pain in uppder abdomen with bloating, belching and nausea
  • no obvious cause!
  • common / long-lasting
  • current Tx generally unsatisfactory due to lack of pathophysiological basis
  • when FD patients have postprandial fullness/early satiety - subclassed as postprandial distress syndrome (PDS)
  • with epigatsric burning/pain - subclassed as epigastric pain syndrome (EPS)
29
Q

What is a low FODMAP diet?

A

“Fermented Oligosaccharides, Disaccharides, Monosaccharides And Polyols”
* short-chain carbs not absorbed properly in gut
* when in small intestine = move slowly, attracting water
* when in large instine, fermented by gut bacteria, producing gas

Extra gas + water = instestinal wall stretch and expand
–> people with IBS causes exaggerated sensations of pain and discomfort

30
Q

What is Coeliac disease?

A

Immune reaction in SI to eating gluten - a protein in wheat, barley and rye
- over time, reaction damages SI lining, causes malabsorption
- altered gut microbiota -may be responsible

Causes: diarrhea, fatigue, weight loss, bloating and anaemia

No CURE!! - follow strict GF diet to manage Sx and promote intestinal healing

1y after GF diet - more likely Dx with metabolic syndrome

People with Celiac disease on GF diet rep high Tx burden (comparable with end-stage renal disease), up to 30% rep -ve Sx (GI upset) and sleep disturbances

31
Q

What is diverticulitis?

A
  • small, bulging pouches that can form lining of digestive system
  • commonly found in lower colon
  • common esp. >40y
  • when pouch/es become inflammed = diverticulitis

Sx:
* severe abdominal pain, fever, nausea and change in bowel habits

Mild = Tx with rest, diet and antibiotics
Sev/recurring = may requir surgery

32
Q

What is the prevalence of GI conditions in AUS?

A
  • 30% of adults >50 y havev GI complaint
  • IBD ~ 0.3% = 61,000
  • 28,000 Crohn’s Disease
  • 33,000 Ulcerative Colitis
  • GORD ~ 15%
  • IBS ~ 20%, 2x more in women/younger individuals.
  • Coeliac Disease ~ 1.3% (1 in 70) // 80% remain unDx
  • Incidence 4-5fold over past 50y
  • Diverticular Disease - 5% in 40y/younger, 65% by 85y
33
Q

What are the comorbidities of having GI tract condition?

A

Inflammatory Conditions – A ‘Flare-Up’
* reappearance of Sx
* prescribe corticosteroids - reduce immune system to fight inflammation
* usually avoid Ex during flare-up – dependant Sx
* Mod Ex +vely modulates intestinal immune system
while sev Ex is immunosuppressive

Mental Health
* High levels of poor mental health
* Very prevalent in IBS, UC and FD
Attributed to…
* general psych stress of suffering from chronic/debilitating disease
* derangement of GBA involving dysbiosis
(microbial imbalance) impacting neurocognitive function.

34
Q

What the hazards of Ex and general GI health?

A

Sx: nausea, heartburn, diarrhoea, GI bleeding common (20-40%) during Ex, esp. HIIT aerobic endurance activities (esp. long-distance running & triathlon)

Sx:
* transient, no long term consequences
* progressive leading to cessation of Ex or decrease intensity.
* Serious Sx limit Ex performance/participation

Mechanisms of Ex causing GI Sx not well known:
* decreased GI blood flow
* increased GI motility
* increased mechanical bouncing
* altered neuroendocrine modulation

35
Q

What are some GI health hazards from Ex based on evidence?

A

Single bout of long high intensity = gut damage/gut permeability
damaged exacerbated in hot environments

GI bleeding most serious

Repeated GI bleeding =
* iron deficiency and anaemia
* endotoxaemia
* malabsorption
* GI inflammation

Dehydration exacerbates condition

36
Q

What are the benefits of Ex on general GI health?

A
  • decrease risk of colon cancer
  • retrospective and prospective studies indicate Ex benefits disease course and QoL
  • reduces GI bleeding
  • inhibit appetite
  • functional capacity
  • general wellbeing by +ve mood changes
  • sleep
  • BMD
37
Q

Explain the relationship between PA and IBD?

A

People with Crohn’s Disease completed less mod-vig Ex than controls
- long disease duration, low BMI, low VitD3 and inflammation evidenced by elevated serum C-reactive protein associated with low PA
- Italisn study - 21% with IBD regularly Ex
- Ex rates fluctuate with patient’s disease activity

38
Q

Why are some patients with IBD hesitant to seek Ex options and what is another main concern?

A

Ongoing GI Sx (e.g. diarrhea), may be hesitant Ex outside of home or in areas without bathroom access

Sx exacerbation is another main concern.
* 79% rep IBD limited participation
* abdominal/joint pain, fatigue, flare-ups and increased fecal urgency
* in healthy patients, strenuous, HIIT reduces blood flow to digestive system, can be exacerbated by hypovolaemia due to dehydration

–> may be responsible of ischaemic colitis in HIIT endurance athletes (e.g marathoners and triathletes)

39
Q

Was Ex responsive for IBD patients – esp. British patient study?

A

72% rep Ex improved Sx

23% rep Ex exacerbated IBD symptoms:
- 41% rep fatigue
- 12% rep increased toilet needs
- 17% rep abdominal pain
- increase joint pain, IBD Sx and increased Rx time

40
Q

What evidence of prospective studies demonstrate little danger of Sx exacerbation in people with IBD?

A
  • 30mins cycling at 50% peak capacity and HIIT = similar increases in inflammatory markers between IBD and controls
  • all inflammatory markers returned to baseline within 60mins after Ex session
  • transient nature of elevations suggest little danger of Sx exacerbation

Limited data suggest even HIIT is safe in selected IBD patients.

41
Q

Explain the relationship between PA and GORD.

A

Cross-sectional
Ex (>30mins, 3x/wk) -vely correlated with GORD

No studies investigating an Ex intervention

42
Q

Explain the relationship between PA and IBS.

A

Bowel movements more frequent and colon transit more rapid in PA individuals than sedentary
* Systematic review of 14 RCT found
* Ex is safe
* GI Sx, QOL, anxiety, and IBS-related comorbidities
= improvements with Ex compared to usual care
* More research needed

43
Q

Explain the relationship between PA and coeliac disease.

A
  • 50% od low PA levels
  • metabolic bone disease = frequent co-morbidity
  • ~75% new Dx patients have low BMD and 40% greater risk of fractures
  • promote weight-bearing and resistance Ex
44
Q

A client asks whether Ex will improve his Crohn’s disease Sx. What would you say?

A
  • People who are inactive will have more GI symptoms
    associated with their condition
    *Likely due to increased inflammation when people are sedentary
  • Unfortunately, there is little high level evidence for benefits of Ex on Crohns’s Disease
  • It is likely that the ‘right amount’ of exercise will create an anti-inflammatory
    environment that will improve GI symptoms and quality of life

EXMD4743 (9 decks)

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