Functional GI Disorders

Question 1

What are the two categories of GI disease?

Answer 1

Functional
Structural

Question 2

Which category of GI disease is there more likely to be detectable pathology?

Answer 2

Structural GI disease

Question 3

List some functional GI diseases.

Answer 3

Oesophageal spasm
Non-ulcer dyspepsia
Biliary dyskinesia
IBS
Slow transit constipation

Question 4

Describe what happens in patients with non-ulcer dyspepsia.

Answer 4

Ulcer like pain but in absence of ulcer

Question 5

Which part of the history is particularly important for the diagnosis of non-ulcer dyspepsia?

Answer 5

Family history, in particular gastric cancer or coeliac disease

Question 6

Which other things are important to check if suspicious of non-ulcer dyspepsia?

Answer 6

H.pylori status
Alarm symptoms

Question 7

If a patient is negative for H.pylori and does not have any family history or alarm symptoms, how would you treat it?

Answer 7

Symptomatically to relieve symptoms, usually with proton pump inhibitors

Question 8

If a patient is positive for H.pylori, how would it be treated?

Answer 8

Eradication therapy

Question 9

If there is any doubt about a patient’s symptoms concerning the diagnosis of non-ulcer dyspepsia, what can be done?

Answer 9

Endoscopy

Question 10

What is nausea?

Answer 10

Sensation of feeling sick

Question 11

What is retching?

Answer 11

Dry heaves- stomach contracts but the glottis is closed

Question 12

What is vomiting?

Answer 12

Stomach contents expelled

Question 13

What is important to ask when taking a history from someone with vomiting and nausea?

Answer 13

How long after eating the symptoms occur

Question 14

What does it mean if sickness or vomiting usually occurs immediately after eating?

Answer 14

It’s psychogenic

Question 15

What does it mean if sickness or vomiting usually occurs an hour or more after eating?

Answer 15

Pyloric obstruction
Motility disorders

Question 16

What does it mean if sickness or vomiting usually occurs 12 hours after eating?

Answer 16

Obstruction further down the GIT

Question 17

List some of the functional causes of nausea/vomiting.

Answer 17

Drugs
Pregnancy
Migraines
Cyclical vomiting syndrome
Alcohol

Question 18

Describe the rare disorder known as cyclical vomiting disorder.

Answer 18

Often presents in childhood, patients get recurrent episodes of severe vomiting.
Can happen a few times a month or few times a year, usually requires hospital admission and IV fluids

Question 19

Name two lower GI diseases.

Answer 19

IBS
Slow transit constipation

Question 20

How do you assess patients on their gut function?

Answer 20

Ask them what is normal for them and how it has changed

Question 21

What questions can we ask about stool?

Answer 21

Change in consistency/frequency?
Blood present- either on wiping or mixed with the stool?

Question 22

Which chart may be useful for describing stool consistency?

Answer 22

Bristol stool chart

Question 23

Describe the three parts of examination for patients who may have GIT disorders.

Answer 23

General examination looking for systemic disease
Abdominal examination
Rectal examination

Question 24

List the Alarm symptoms for lower GIT disorders.

Answer 24

Age >50
Short symptom history
Nocturnal symptoms
Family history
Male
Anaemia
Rectal bleeding
Abdominal mass

Question 25

List the investigations used for those with suspected lower GIT disorders.

Answer 25

FBC Blood glucose U+E's etc Thyroid status Coeliac serology FIT test Sigmoidoscopy

Question 26

What does FIT testing involve?

Answer 26

Checking for traces of human haemoglobin in stool

Question 27

What is constipation?

Answer 27

When the bowel does not get properly emptied

Question 28

What are some of the organic causes of constipation?

Answer 28

Strictures Tumours Diverticular disease Proctitis Anal fissures

Question 29

What are some of the functional causes of constipation?

Answer 29

Megacolon Idiopathic constipation Depression Psychosis Institutionalised patients (those who have been in hospital for a long time)

Question 30

What are some of the systemic causes of constipation?

Answer 30

Diabetes Hypothyroidism Hypercalcemia

Question 31

What are some of the neurogenic causes of constipation?

Answer 31

Autonomic neuropathies Spina bifida Multiple sclerosis Parkinson's Strokes

Question 32

What are the clinical features of IBS?

Answer 32

Abdominal pain Altered bowel habit Abdominal bloating

Question 33

What do the ROME classification guidelines say about symptoms required to diagnose IBS?

Answer 33

Recurrent abdominal pain/discomfort for >3 days/month in past three months with two of the following- 1. Improvement w defaecation 2. Onset associated with change in stool form 3. Onset associated with change in stool frequency

Question 34

Describe the abdominal pain felt in patients with IBS.

Answer 34

Vague Burning Bloating Sharp Occasionally radiates to lower back

Question 35

Does IBS related abdominal pain occur during the day or night?

Answer 35

Day, nocturnal IBS pain is uncommon

Question 36

What relieves IBS related pain usually?

Answer 36

Defaecation

Question 37

What is meant by IBS-C?

Answer 37

Constipation predominant IBS

Question 38

What is meant by IBS-D?

Answer 38

Diarrhoea predominant IBS

Question 39

What is meant by IBS-M?

Answer 39

Mixed diarrhoea and constipation IBS

Question 40

Bloating is a very common symptom of IBS. Describe the bloating experienced in those with IBS.

Answer 40

Often very prominent Can cause wind or flatulence

Question 41

What causes the bloating seen in those with IBS?

Answer 41

Relaxation of abdominal muscles

Question 42

List some investigations used for IBS

Answer 42

Blood analysis FBC U&E, LFTs Ca CRP Coeliac serology Stool culture FIT testing Calprotectin Rectal examination ?Colonoscopy

Question 43

What is calprotectin?

Answer 43

Inflammatory protein released by inflamed gut mucosa

Question 44

What is calprotectin used for?

Answer 44

To differentiate between IBS from IBD To monitor IBD

Question 45

Are calprotectin levels raised in IBS or IBD?

Answer 45

IBD Normal in IBS

Question 46

What is the treatment for IBS?

Answer 46

Education and reassurance Diet review

Question 47

What is the FODMAP diet which is followed by some IBS patients?

Answer 47

Exclusion diet...idk how much you need to know in detail but helps a patient to work out if there are any triggers

Question 48

Give an example of a type of drug which can help relive IBS patients of pain.

Answer 48

Antispasmodics Linoclotide

Question 49

Give an example of a type of drug which can help relive IBS patients of bloating.

Answer 49

Some probiotics Linoclotide

Question 50

Give an example of a type of drug which can help relive IBS patients of constipation.

Answer 50

Laxatives

Question 51

Give an example of a type of drug which can help relive IBS patients of diarrhoea.

Answer 51

Antimotility agents FODMAP

Question 52

Name the psychological treatment options for functional GIT disorders.

Answer 52

Hypnotherapy Relaxation therapy Cognitive behavioural therapy Psychodynamic interpersonal therapy

Question 53

Describe the muscular contractions of the large intestine of those with IDB-D.

Answer 53

Contractions may be larger and more frequent.

Question 54

Describe the muscular contractions of the large intestine of those with IDB-C.

Answer 54

Contractions reduced

Question 55

What can trigger contractions of the large intestine?

Answer 55

Walking Eating

Question 56

What can happen if those who have IBS get stressed?

Answer 56

Their IBS becomes chronic as gut is more sensitive to stress

Question 57

Which oil can be beneficial to those with IBS?

Answer 57

Peppermint oil