Bowel Disorders

Question 1

what are the 2 broad categories of GI disease?

Answer 1

> structural

> functional

Question 2

what are the effects of functional GI disorders?

Answer 2

> impact quality of life
cause absence from work
no association with development of serious pathology

Question 3

what could cause non-ulcer dyspepsia?

Answer 3

> reflux
low grade duodenal ulceration
delayed gastric emptying
irritable bowel syndrome

Question 4

how would you diagnose non-ulcer dyspepsia?

Answer 4

> history and examination
h. pylori status
alarm symptoms

Question 5

is all investigations are negative in the diagnosis of non-ulcer dyspepsia how do you proceed?

Answer 5

> treat symptomatically

> do endoscopy if in doubt

Question 6

describe retching

Answer 6

dry heaves where the antrum contracts but the glottis is closed

Question 7

what would immediate vomiting after eating suggest?

Answer 7

it is psychogenic

Question 8

in obstruction how long would you expect there to be between eating and vomiting?

Answer 8

12 hours

Question 9

what conditions may cause vomiting an hour or more after eating?

Answer 9

> pyloric obstruction

> motility disorders: diabetes, post gastrectomy

Question 10

name some functional causes of vomiting

Answer 10

> drugs
> pregnancy
> migraine
> cyclical vomiting 
> alcohol

Question 11

name some functional diseases of the lower GI tract

Answer 11

> irritable bowel syndrome

> slow transit constipation

Question 12

what would you consider when asking about changes in bowel habit?

Answer 12

> what is their normal
> changes in frequency
> changes in consistency
> blood present
> mucus

Question 13

name some alarm symptoms

Answer 13

> >50years
> short history
> weight loss
> nocturnal symptoms
> male
> family history of cancer
> anaemia
> rectal bleeding
> antibiotic use
> abdominal mass

Question 14

what is the aetiology of constipation? (four broad categories)

Answer 14

> systemic
neurogenic
organic
functional

Question 15

what investigations could you carry out when assessing the patient after history is taken?

Answer 15

> FBC
> U and Es
> blood glucose
> thyroid status
> coeliac serology
> proctoscopy
> sigmoidoscopy
> colonoscopy

Question 16

what organic things can cause constipation?

Answer 16

> strictures
> tumours
> diverticular disease
> proctitis
> anal fissure

Question 17

what functional reasons can there be for constipation?

Answer 17

> megacolon
> idiopathic
> depression
> psychosis
> institutionalisation

Question 18

what are the systemic causes of constipation?

Answer 18

> diabetes mellitus
hypothyroidism
hypercalcaemia

Question 19

what are the neurogenic causes of constipation?

Answer 19

> autonomic neuropathies
> parkinson's disease
> strokes
> multiple sclerosis
> spina bifida

Question 20

what are the clinical features of irritable bowel syndrome?

Answer 20

occur relapsing and remitting manner:
> abdominal pain
> altered bowel habit
> abdominal bloating
> wind

Question 21

what are the features of abdominal pain in IBS?

Answer 21

> variable character
occasionally radiates to lower back
often altered by bowel action
rarely occur at night

Question 22

describe altered bowel habit in IBS

Answer 22

> constipation (IBS-C)
> diarrhoea (IBS-D)
> diarrhoea and constipation (IBS-M)
> variable
> urgency

Question 23

what causes bloating in IBS?

Answer 23

relaxation of the abdominal wall muscles

Question 24

how would you diagnose IBS?

Answer 24

> compatible history

> normal physical examination

Question 25

what investigations could you carry out for IBS?

Answer 25

> blood analysis > stool culture > calprotectin

Question 26

what releases calprotectin?

Answer 26

inflamed gut mucosa

Question 27

what is calprotectin used for clinically?

Answer 27

differentiating IBS from IBD and monitoring IBD

Question 28

what is the treatment for IBS?

Answer 28

``` > education and reassurance > diabetic review > drug therapy > relaxation training > hypnotherapy > cognitive behaviour therapy > psychodynamic interpersonal therapy ```

Question 29

what can cause IBS?

Answer 29

> altered motility > visceral hypersensitivity > stress/anxiety/depression

Question 30

how do contractions of the bowel differ in IBS-D?

Answer 30

they are stronger and more frequent

Question 31

describe bowel contractions in IBS-C

Answer 31

they are reduced

Question 32

how may contractions of the bowel be triggered?

Answer 32

by waking or eating

Question 33

what type of IBS has a greater response to trigger of gut contractions?

Answer 33

IBS-D

Question 34

how does awareness of normal digestive processes differ in people with IBS?

Answer 34

they often have excessive awareness