Functional bowel disorders

Question 1

What are the main functional bowel disorders?

Answer 1

Oesophageal spasm

Non-Ulcer Dyspepsia (NUD)

Biliary Dyskinesia

Irritable Bowel syndrome

Slow Transit Constipation

Drug Related Effects

Question 2

Functional disorders have a good long term prognosis because there is no detectable __________

Answer 2

pathology

Question 3

Most functional bowel disorders can be traced back to a ________ cause

Answer 3

psychological cause

Question 4

What is Non-ulcer dyspepsia (NUD)?

Answer 4

Repeated Dyspepsia (indigestion) in which there is no definite organic cause

Question 5

What is thought to cause non-ulcer dyspepsia?

Answer 5

Probably some combination of:

Reflux

Low grade duodenal ulceration

Delayed gastric emptying

Irritable bowel syndrome

Question 6

If someone vomits immediately after eating, the cause is likely…

Answer 6

Psychogenic

Question 7

What are the potential causes for vomitting 1 or more hours after eating?

Answer 7

Pyloric obstruction

Motility disorders such as diabetes or post gastrectomy

Question 8

What would cause vomitting >12 hours after eating?

Answer 8

Obstruction

Question 9

What are the functional causes for vomitting?

Answer 9

Drugs

Pregnancy

Migraine

Alcohol

Clinical vomitting syndrome

Question 10

What is meant by ‘psychogenic vomitting’?

Answer 10

Psychogenic nausea and vomiting is defined as vomiting without any obvious organic pathology or vomiting with a psychological etiology

Question 11

What are the functional bowel disorders of the lower GI tract?

Answer 11

Irritable bowel syndrome (IBS)

Slow transit constipation

Question 12

What is the chart used to identify different types eh pooh

Answer 12

Bristol stool chart

Question 13

What symptoms are ‘alarm bells’ and indicate a more serious illness?

Answer 13

Age >50

Short symptom history

Weight loss

Male

Family history

Nocturnal symptoms

Anaemia

Rectal bleeding

Recent antibiotic use

Abdominal mass

Question 14

What are the possible ‘organic’ causes for constipation?

Answer 14

Strictures

Tumours

Diverticular disease

Proctitis

Anal fissure

Question 15

What are some functional causes for constipation?

Answer 15

Megacolon

Idiopathic constipation

Depression

Psychosis

Institutionalised patients

Question 16

What are the systemic causes of constipation?

Answer 16

Diabetes mellitus

Hypothyroidism

Hypercalcaemia

Question 17

WHat are the neurogenic causes for constipation?

Answer 17

Autonomic neuropathy

Parkinson’s

Strokes

Multiple sclerosis

Spina bifida

Question 18

What are the alternative names for Irritable bowel syndrome?

Answer 18

Spastic colon

Nervous colon

Unstable colon

Mucous colitis

Question 19

What are the main clinical features of IBS?

Answer 19

Abdo pain (variable in character)

Altered bowel habit

Abdo bloating

Belching wind / flatulence

Mucous in stool

Question 20

What sort of pain is associated with IBS?

Answer 20

Variable in nature (sharp, dull etc)

Relieved by defecation

Rarely occurs at night

Question 21

What is the difference between IBS-C, IBS-D and IBS-M?

Answer 21

IBS-C = IBS with constipation

IBS-D = IBS with diarrhoea

IBS-M = IBS with diarrhoea and constipation

Question 22

What examination findings would indicate IBS?

Answer 22

None

Question 23

What is calprotectin?

Answer 23

Molecule released by inflamed gut mucosa

Question 24

Why is calprotecting useful in the investigation of IBS?

Answer 24

Can be used to differentiate between IBS and IBD

Question 25

What are the investigations for IBS?

Answer 25

Blood analysis Stool culture Calprotectin FIT testing Rectal examination? Colonoscopy?

Question 26

What is the basic treatment strategy for IBS?

Answer 26

Education & reassurance Dietetic review Drugs

Question 27

What specific diet is recommended for those with IBS?

Answer 27

FODMAS (Fermentable Oligo-, Di- and Mono-Saccharides and Polyols)

Question 28

What drugs can be used to treat the pain in IBS?

Answer 28

Antispasmodics Linaclotide (for IBS-C)

Question 29

What drugs can be used to treat the bloating in IBS?

Answer 29

Some probiotics Linaclotide (for IBS-C)

Question 30

What drugs can be used to treat constipation for those with IBS?

Answer 30

Laxatives Linaclotide (if constipation then avoid the FODMAP diet)

Question 31

What agents can be used to treat the diarrhoea in IBS-D?

Answer 31

Antimotility agents FODMAP diet

Question 32

What psychological interventions can be used to treat IBS?

Answer 32

Relaxation training Hypnotherapy Cognitive behavioural therapy Psychodynamic interpersonal therapy

Question 33

Relaxation therapy is especially useful for treating IBS patients with...

Answer 33

Diarrhoea Psychological comorbidity

Question 34

Hypnotherapy is especially useful for treating IBS patients with...

Answer 34

Pain Constipation Flatulence Anxiety

Question 35

What is cognitive behavioural therapy? When is it most useful?

Answer 35

Identifying symptom triggers and learning how to respond more appropriately Most useful for: Abdo pain, bloating and flatulence

Question 36

When is cognitive behavioural therapy not indicated?

Answer 36

Contraindications are: - Depression - Patients who believe in a physical cause for their symptoms

Question 37

What is psychodynamic interpersonal therapy? When is it useful?

Answer 37

Educating the patient on how their emotions and bowel symptoms interrelate Useful for: - A history of abuse

Question 38

What are the contraindications for psychodynamic interpersonal therapy?

Answer 38

Constipation Constant pain Depression

Question 39

What are possible underlying causes of IBS?

Answer 39

Altered motility Visceral hypersensitivity Stress, anxiety, depression

Question 40

How would altered motility lead to IBS?

Answer 40

Increased motility = IBS-D Reduced motility = IBS-C IBS-M = get facked