Functional Bowel Disorders

Question 1

What is a functional GI disease?

Answer 1

No detectable pathology, that are related to gut function and they have good long-term prognosis Software faults

Question 2

What is a structural GI disease?

Answer 2

Detectable pathology e.g. Macroscopic - Cancer or Microscopic - Colitis

Question 3

What are different types of functional GI disorders?

Answer 3

Oesophageal spasm
Non-Ulcer Dysplasia
Biliary Dyskinesia
Irritable Bowel Syndrome
Slow transit constipation
Drug related effects

Question 4

What does biliary dyskinesia affect?

Answer 4

Gallbladder and Sphincter of oddi

Question 5

Does a structural or functional GI disease have a bigger effect on a patients quality of life?

Answer 5

Functional but they can be diagnosed with history and examination

Question 6

What is Non-Ulcer Dyspepsia (NUD)?

Answer 6

Dyspeptic type pain with no ulcer on endoscopy as the H. pylori status varies

Question 7

How do you diagnose NUD?

Answer 7

Check family history
H. pylori status - Negative = Treat symptoms & Positive = Eradication therapy
Possible endoscopy

Question 8

What is nausea?

Answer 8

The sensation of feeling sick

Question 9

What is retching?

Answer 9

Dry heave with the antrum contracting but the glottis remaining closed

Question 10

What is vomiting?

Answer 10

Contents expelled

Question 11

What do the times of when you have been sick tell you about the cause of it?

Answer 11

Immediately - Psychogenic
1 hour or more - Pyloric obstruction/Motility disorder
12 hours - Obstruction (further down bowel)

Question 12

What are the causes of vomiting?

Answer 12

Drugs
Pregnancy
Alcohol
Migraine
Cyclical Vomiting Syndrome

Question 13

When is pyschogenic vomiting often seen?

Answer 13

Often in young women who have no preceding nausea Can be self-induced and doesn’t affect appetite

Question 14

What are features of IBS?

Answer 14

Altered bowel habit - Constipation? Diarrhoea? Urgency?
Abdominal pain
Abdominal bloating
Belching wind
Flatus
Mucus

Question 15

What is the criteria for IBS?

Answer 15

3 months of abdominal pain:
Relieved by defaecation
Associated change of consistency and frequency

AND 2 or more:
Altered stool frequency/form/passage
Passage of mucus
Bloating

Question 16

What are the causes of IBS?

Answer 16

Altered motility
Visceral hypersensitivity
Stress, Anxiety & Depression

Question 17

What are the investigations of IBS?

Answer 17

Blood analysis
Stool culture
Faecal calprotectin
Rectal examination
Colonoscopy if in doubt

Question 18

What does calprotectin show?

Answer 18

Protein released by inflamed mucosa and is detected in the stool so can differentiate between IBS & IBD
Will be raised in bowel cancer

Question 19

What is the treatment for IBS?

Answer 19

Education and reassurance

Dietetic review

Question 20

How do muscular contractions compare for constipation and diarrhoea in IBS patients?

Answer 20

Constipation - Contraction may be reduced

Diarrhoea - Stronger and more frequent contractions

Question 21

What do people with IBS often have?

Answer 21

Heightened awarenes of normal digestive processes

Question 22

What does the brain receive in IBS?

Answer 22

Too strong a signal from the gut telling it is hungry/has a toilet urge

Question 23

What do you look for on examination in a patient with a functional bowel disorder?

Answer 23

Look for systemic disease
Careful abdominal examination
Rectal examination
FOB

Question 24

What investigations do you for a patient with a functional bowel disorder?

Answer 24

FBC & U+E's
Glucose
Thyroid status - Hypothyroid can cause constipation
Coeliac serology
Proctoscopy & Sigmoidoscopy

Question 25

What is the aetiology of constipation plus an example?

Answer 25

Systemic - Widespread issue e.g. Diabetes
Neurogenic - Brain is causing this e.g. Stroke, MS or Spina Bifida
Organic - Something is physically wrong e.g. Tumour or Anal fissure
Functional - Something just isn’t working right e.g. Depression, Psychosis or a Megacolon

Question 26

What is a megacolon?

Answer 26

An abnormal dilation of the colon

Question 27

What pyschological factors play a role in GI disease?

Answer 27

Anorexia
Bulimia
Butterflies and diarrhoea in response to stress
In IBS the gut is more sensitive to stress - Response can become chronic