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Systems: Alimentary AB > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What are the 2 broad categories of GI disease?

A
  • Structural

- Functional

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2
Q

Describe a structural GI disorder.

A
  • Detectable pathology: macroscopic/microscopic
  • Usually both
  • Prognosis depends on pathology
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3
Q

Describe a functional GI disorder.

A
  • No detectable pathology
  • Related to gut function
  • “Software” faults
  • Long-term prognosis good
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4
Q

Give 6 examples of functional GI disorders.

A
  • Oesophageal spasm
  • Non-ulcer dyspepsia
  • Biliary dyskinesia
  • Irritable bowel syndrome
  • Slow transit constipation
  • Drug related effects
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5
Q

What are functional GI disorders responsible for?

A
  • Initial and return consultations
  • Large impact on quality of life
  • Work absence
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6
Q

How can a large majority of functional GI disorders be diagnosed?

A

History and examination

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7
Q

Other than physical , what other factors are important with functional GI disorders?

A

Psychological

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8
Q

What are functional GI disorders not associated with?

A

Development of serious pathology

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9
Q

What type of pain is experienced with non-ulcer dyspepsia?

A

Dyspeptic pain

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10
Q

What is found on investigation of non-ulcer dyspepsia?

A
  • No ulcer on endoscopy

- H pylori status varies

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11
Q

What possibly contributes to non-ulcer dyspepsia?

A
  • Reflux
  • Low grade duodenal ulceration
  • Delayed gastric emptying
  • Irritable bowel syndrome
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12
Q

How is a diagnosis of non-ulcer dyspepsia made?

A
  • History + examination
  • H pylori status
  • Alarm symptoms
  • If all negative then treat symptomatically
  • If H pylori positive then eradication therapy
  • If in doubt then endoscopy
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13
Q

Nausea

A

The sensation of feeling sick

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14
Q

Retching

A
  • Dry heaves

- Antrum contracts, glottis closed

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15
Q

Vomiting

A

Contents expelled

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16
Q

What neural control is responsible for vomiting?

A
  • Sympathetic and vagal components
  • Vomiting centre (may not exist as entity)
  • Chemoreceptor Trigger Zone
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17
Q

What may stimulate the CTZ?

A
  • Opiates
  • Digoxin
  • Chemotherapy
  • Uraemia
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18
Q

What is important to note in the history of vomiting?

A

-Length of time after food ingested

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19
Q

What could immediate vomiting after food suggest?

A

Psychogenic

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20
Q

What could vomiting 1 hour or more after ingestion of food suggest?

A
  • Pyloric obstruction

- Motility disorders such as diabetes or post gastrectomy

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21
Q

What could vomiting 12 hours after ingestion of food suggest?

A

Obstruction

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22
Q

What are functional causes of vomiting?

A
  • Drugs
  • Pregnancy
  • Migraine
  • Cyclical vomiting syndrome
  • Alcohol
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23
Q

What is cyclical vomiting syndrome?

A
  • Onset in childhood

- Recurrent episodes 2-3 x a year for 2-3 times a month

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24
Q

Describe psychogenic vomiting?

A
  • Often young women
  • Often for years
  • May have no nausea
  • May be self induced
  • Appetite undisturbed
  • May lose weight
  • Often stops shortly after admission
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25
Name 2 functional diseases of the lower GIT?
- IBS | - Slow transit constipation
26
What is normal bowel habit?
- Varies greatly so no definitive normal | - Whatever is normal for the patient is their normal
27
What are the 2 ends of the Bristol stool chart?
- Type 1 pellets | - Type 7 watery with no solids
28
What should be included in examination for lower GIT?
- Evidence of systemic disease - Abdominal examination - Rectal examination - FOB
29
What are the alarm symptoms?
- >50 years old - Short symptom history - Unintentional weight loss - Nocturnal symptoms - Male - Family history - Anaemic - Rectal bleeding - Recent antibiotic use - Abdominal mass
30
What investigations should be carried out for lower GIT?
- FBC - Blood glucose - U+Es - Thyroid function - Coeliac serology - Protoscopy - Sigmoidoscopy - Colonoscopy
31
What are the types of aetiology for constipation?
- Systemic - Neurogenic - Organic - Functional
32
Give 5 organic causes of constipation.
- Strictures - Tumours - Diverticular disease - Proctitis - Anal fissure
33
Give 5 functional causes of constipation.
- Megacolon - Idiopathic constipation - Depression - Psychosis - Institutionalised patients
34
Give 3 systemic causes of constipation.
- Diabetes mellitus - Hypothyroidism - Hypercalcaemia
35
Give 5 neurogenic causes of constipation.
- Autonomic neuropathies - Parkinson's disease - Strokes - Multiple sclerosis - Spina bifida
36
What are 5 clinical features of IBS?
- Abdominal pain - Altered bowel habit - Abdominal bloating - Belching wind and flatus - Mucus
37
Give 5 ways in which abdominal pain could be described?
- Vague - Bloating - Burning - Sharp - Colicky
38
How can abdominal pain radiate?
To the lower back
39
What may abdominal pain be due to?
Bowel distension
40
What can alter abdominal pain?
Bowel action
41
What are the 2 types of IBS?
- Constipation predominant | - Diarrhoea predominant
42
What are the features of altered bowel habit in IBS?
- Constipation (IBS-C) - Diarrhoea (IBS-D) - Diarrhoea and constipation (IBS-M) - Variability - Urgency
43
What may bloating be due to?
- Wind and flatulence | - Relaxation of abdominal wall muscles
44
What must be true for a diagnosis of IBS?
- A compatible history | - Normal physical examination
45
What blood analysis would be carried out when investigating for IBS?
- FBC - U+Es - Ca - CRP - TFT - Coeliac serology
46
What investigations would be carried out for IBS?
- Stool culture - Calprotectin - Rectal examination and FOB - Colonoscopy
47
What is calprotectin?
- Calprotectin is released by inflamed gut mucosa | - It is used to differentiate IBS from IBD and for monitoring IBD
48
What is the treatment for IBS?
- Education and reassurance | - Dietetic review
49
What are 4 common causes of diarrhoea?
- Tea - Coffee - Alcohol - Sweetners
50
What can drug products help to relieve in IBS?
- Pain - Bloating - Constipation - Diarrhoea
51
What psychological interventions are there for IBS?
- Relaxation therapy - Hypnotherapy - Cognitive behavioural therapy - Psychodynamic interpersonal therapy
52
What can cause IBS?
- Altered motility - Visceral hypersensitivity - Stress, anxiety, depression
53
What is the bowel?
A muscular tube that squeezes content from one end to the other
54
What happens to bowel in IBS-D?
Muscular contractions may be stronger
55
What happens in IBS-C?
Muscular contractions may be reduced
56
What can trigger contractions of the gut?
Waking and eating
57
How might the gut respond to triggers in IBS-D?
Stronger
58
How might the gut respond to triggers in IBS-C?
Reduced response
59
What messages can the brain receive from the gut?
- Hunger | - Urge to go toilet etc
60
How does the brain "hear" messages from the gut in IBS?
Too loudly
61
What type of awareness of digestive processes do people with IBS have?
Excessive awareness
62
What is the biopsychosocial link in IBS?
-Psychological influences, early life and psychological influences act on the brain-gut axis = IBS outcomes
63
How does the stress response become chronic?
In IBS the gut is more sensitive to stress

Systems: Alimentary AB (37 decks)

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