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Alimentary System: Pathology SA > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What is the two categories of GI diseases

A

Structutal

Functional

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2
Q

What is the features of structural GI diseases

A

Detectable Pathology

Usual affects function

Prognosis depends on pathology

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3
Q

What is the features of functional GI diseases

A

No detectable pathology

Related to gut function
Long-term prognosis good

psychological factors important

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4
Q

What are six examples of functional GI disorders

A

Oesophageal spasm

Non-Ulcer Dyspepsia - symptoms without ulcers

Biliary Dyskinesia

Irritable Bowel syndrome

Slow Transit Constipation

Drug Related Effects

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5
Q

Define Biliary Dyskinesia

A

Bile cannot properly move in the proper direction through tubular glands

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6
Q

What other diseases is non ulcer dyspepsia accosiated with

A

Reflux

Low grade duodenal ulceration

Delayed gastric emptying

Irritable bowel syndrome

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7
Q

What is investigated in Non ulcer Dyspepsia

A

Because the the presence of no ulcers with dyspeptic type pain the H. Pylor status is investigated

(as well as gastric cancer caused by H.pylori)

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8
Q

How is Non ulcer dyspepsia investigated

A

Endoscopy

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9
Q

How do you treat non ulcer dyspepsia

A

H.pylori negative and no alarm symptoms- treat acid suppression e.g. omeprazole

H.Pylor postive - Eradication

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10
Q

Define:

  1. Nausea
  2. Retching
  3. Vomiting
A
  1. Sensation of feeling sick
  2. Dry heaves
  3. Contents expelled
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11
Q

What is the mechanism of retching

A

Antrum contracts while glottis is closed so nothing is expelled

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12
Q

Vommiting has both sympathetic and vagal components what receptors do these act upon

A

Vomiting centre

Chemoreceptor trigger zone
   Receptors for opiates
   Digoxin
   Chemotherapy
   Uraemia
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13
Q

What causes you to vomit food immediately/ 1 hour after/12 hours after

A

Immediately:
psychogenic factor

> 1Hr:
-Pyloric obstruction
-Motility disorders (diabetes,
post gastrectomy)

12hrs:
Obstruction

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14
Q

What is functional causes of vomiting

A

Drugs

Pregnancy

Migraine
- causes abdominal pain

Cyclical Vomiting Syndrome (recurrent attacks)

Alcohol

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15
Q

What is the features of psychogenic vomiting

A

Happens with no preceding nausea

  • potentially self induced
  • appetite usually not disturbed
  • may lose weight
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16
Q

What are the two specific functional disease of the Lower GI tract

A

Irritable bowel syndrome

slow transit constipation

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17
Q

What questions are asked in History taking of abnormal gut function

A

What is normal to the patients

  • Change in frequency
  • Blood in stool
  • Mucus in stool
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18
Q

What are the alarm symptoms of bowel function problems

A

Over 50 years

Short symptomatic history

unintentional weight loss

Nocturnal symptoms

Family history of bowel/ovarian cancer

Anemia
rectal bleeding

Recent antibiotic use

Males (report less)

Abdominal Mass

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19
Q

What are the investigations used when assessing bowel function problems

A

FBC
Blood glucose
U + E,

Thyroid status

Coeliac serology

Proctoscopy - examine anus

Sigmoidoscopy - examine sigmoid by

Colonoscopy

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20
Q

What is the 4 category aetiology of constipation

A

Systemic
Neurological
Organic
Functional

21
Q

What is the causes or organic constipation

A 
Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure
22
Q

What is the causes or Functional constipation

A

Megacolon

Idiopathic constipation

Depression

Psychosis

Institutionalised patients

23
Q

What is the cause of systemic constipation

A

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

24
Q

What is the causes of neurological constipation

A 
Autonomic neuropathies
Parkinson's disease
Strokes
Multiple sclerosis
Spina bifida
25
Q

What is the symptoms of irritable Bowel Syndrome

A

abdominal pain

altered bowel habit

abdominal bloating

Belching wind and flatus

Mucus

26
Q

What is the diagnostic criteria for IBD

A

Recurrent abdominal pain/discomfort for over 3 days a months in the past 3 months
associated with two or more symptoms

  • improvement with defecation
  • onset associated with change in stool frequent
  • onset associated with change in stool form
27
Q

What is the 4 variabilites of the abdominal pain in IBS

A

Vague
Bloating
Burning
Sharp

28
Q

What is the cause of the abdominal pain in IBS

A

Bowel distension caused by altered bowel action

29
Q

Does symptoms of IBS occur at night

A

No, rarely occurs

30
Q

What is the different patterns of altered bowel habit in IBS

A

Constipation (IBS-C)

Diarrhoea (IBS-D)

Both diarrhoea and constipation (IBS-M)

Variability

Urgency

31
Q

What is the presentation of bloating in IBS

A

Very prominent, due to relaxation of abdominal wall muscle

accompanied by

  • Wind and flatulence
  • Mucus in stools
  • Upper GI symptoms
32
Q

What is the physical examinations that take place for diagnosing functional bowel diseases

A

Look for systemic disease

Abdominal examination

rectal examination

fecal occult blood test

33
Q

What are the investigations carried out for the diagnosis of Irritable bowel syndrome

A 
Blood analysis:
FBC
U & E,
LFTs, 
Ca
CRP (inflammatory marker)
Thyroid function 
Coeliac serology

Stool culture

Calprotectin

Rectal examintaion + FOB

Colonoscopy - investigate concerning features

34
Q

Why do we test for calprotectin

A

Is released by inflamed gut (IBD) mucosa into your stool

Differentiated IBS from IBD
-monitors IBD

35
Q

What is the treatment plan for IBS

A

Diet review

Drug therapy
Target: pain, bloating, constipation, diarrhoea

Psychological intervention

36
Q

What is recommended diet with IBS

A 
FODMAP diet 
(fermentable oglio, Di and Mono-saccharides and plyols)

avoid:
tea/coffee/alcohol/sweetener
Exclude:
Lactose, gluten

37
Q

What is examples of drug used to treat pain in IBS

A 
Antispasmodics 
Linaclotide 
Antidepressants 
  TCA, 
  SSRIs
38
Q

What are examples of drugs used to treat bloating

A

Probiotics
Linaclotide

(avoid bulking)

39
Q

What is examples of drugs used to treat constipation

A

Laxatives

  • bulking agents
  • softeners
  • stimulants
  • osmotics

Linaclotide

40
Q

What treatments should be avoided in constipation

A

TCA

FODMAP

41
Q

What drugs are used to treat diarrhoea in IBS

A

Anti motility agents

FODMAP

42
Q

What are you recommended to avoid with the symptoms of diarrhoea

A

SSRIs

43
Q

What is examples of psychological intervention

A

Relaxation training

Hypnotherapy (relaxation)

Cognitive behavioural therapy (identify symptoms and respond)

Psychodynamic interpersonal therapy (how emotions and bowels interrelate)

44
Q

What us the affect on the muscular tube in IBS-D patients

A

Muscular contractions may be stronger and more frequent than normal

45
Q

What is the affect of the IBS-C on the muscular tube

A

Contraction may be reduced

46
Q

Contractions can be triggered by waking and eating

what affect does IBS have on these triggers

A

In IBS-D, the response to these normal triggers may be stronger than normal.

In IBS-C, the response may be reduced

47
Q

What affect does IBS have on the brain

A

Increases the strength of gut messages

48
Q

What affect does IBS patients have on normal digestive process

A

Have an excessive awareness of digestive process

49
Q

What affect does the psychosocial influences have on the physiological influences of IBS

A

IBS, the gut is more sensitive to stress, and this response can become chronic

Alimentary System: Pathology SA (27 decks)

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