Functional Bowel Disorders

Question 1

What is a functional bowel disorder?

Answer 1

No detectable pathology

Question 2

What is non-ulcer dyspepsia?

Answer 2

Dyspeptic type pain with no ulcer on endoscopy

h.pylori status variable

Question 3

Diagnosis of non-ulcer dyspepsia? (3)

Answer 3

History + exam (inc. FH)
H.pylori status
ALARM symptoms

Question 4

How to treat non-ulcer dyspepsia if:

a) all tests negative
b) H.pylori positive
c) if doubt

Answer 4

a) symptomatic treatment
b) eradication therapy
c) endoscopy

Question 5

What is nausea?

Answer 5

the sensation of feeling sick

Question 6

What is retching?

Answer 6

Dry heave

Antrum contracts, glottis closed

Question 7

What is vomiting?

Answer 7

Contents expelled

Question 8

What is the most likely diagnosis if N&V immediately from food?

Answer 8

Psychogenic vomiting

Question 9

What group is most likely to have psychogenic vomiting?

Answer 9

Young women

Question 10

What are the likely diagnoses if nausea and vomiting 1 hr or more after food? (2)

Answer 10

Pyloric obstruction

Motility disorders

Question 11

What is most likely diagnosis if nausea & vomiting 12 hours or more after food?

Answer 11

Obstruction

Question 12

Name 5 functional causes

Answer 12

Drugs
Pregnancy
Migraine (abdominal)
Cyclical vomiting syndrome
Alcohol

Question 13

5 clinical features of IBS

Answer 13

Abdominal pain
Altered bowel habit
Abdominal bleeding
Belching wind & flatus/bloating
Mucus in stools

Question 14

Description of abdominal pain associated with IBS (4)

Answer 14

variable (vague, bloating, burning, sharp)
Replicated by balloon inflation
Occasionally radiates (often lower back)
Rarely occurs at night

Question 15

What defines IBS-C?

Answer 15

Constipation

Question 16

What defines IBS-D?

Answer 16

Diarrhoea

Question 17

What defines IBS-M?

Answer 17

Constipation & diarrhoea

Question 18

What diagnoses IBS?

Answer 18

History + normal exam

Question 19

Investigations in IBS? (6)

Answer 19

Blood analysis (check coeliac)
Stool culture
Calprotectin
FIT testing
Rectal examination
Colonoscopy?

Question 20

What is FIT testing?

Answer 20

Faecal Immunochemical Test

Question 21

Treatment of IBS?

Answer 21

Firm diagnosis
Education & reassurance
Dietetic review
Tea, coffee, alcohol, sweetener
Lactose, gluten exclusion trial
FODMAP

Question 22

Treatment for IBS pain? (3)

Answer 22

Antispasmodics
Linaclotide (IBS-C)
Antidepressants

Question 23

Treatment for IBS bloating? (2)

Answer 23

Some probiotics

Linaclotide (IBS-C)

Question 24

What is IBS?

Answer 24

Functional bowel disorder with visceral hypersensitivity where the sensory nerve endings have an abnormally strong response to stimuli

Question 25

Signs of IBS? (2)

Answer 25

Abdominal tenderness | Mucus in stool

Question 26

Symptoms of IBS? (3)

Answer 26

Excess gas Abdominal pain Diarrhoea/Constipation

Question 27

Treatment for IBS constipation? (2)

Answer 27

Laxatives | Linaclotide

Question 28

Treatment for IBS diarrhoea? (2)

Answer 28

Antimotility agents | FODMAP

Question 29

Psychological interventions for IBS? (4)

Answer 29

Relaxation training Hypnotherapy Cognitive behavioural therapy Psychodynamic interpersonal therapy

Question 30

Investigations for slow transit constipation? (8)

Answer 30

``` FBC Blood Glc U+E Thyroid status (in hypothyroid gut slows down) Coeliac serology FIT testing Sigmoidoscopy Colonoscopy ```

Question 31

Systemic causes of constipation? (3)

Answer 31

Diabetes mellitus Hypothyroidism Hypercalcaemia

Question 32

Neurogenic causes of constipation? (5)

Answer 32

``` Autonomic neuropathies Parkinson's disease Strokes MS Spina bifida ```

Question 33

Organic causes of constipation? (5)

Answer 33

``` Strictures Tumours Diverticular disease Proctitis Anal fissure ```

Question 34

Functional causes of constipation? (5)

Answer 34

``` Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients ```