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Flashcards in functional GI disorders Deck (16):
1

what is functional GI?

Common, unexplained disorders. Examples :-–Irritable Bowel Syndrome –Functional Dyspepsia –Functional Constipation (most cases) •Chronic abdominal symptoms in the absence of biochemical or structural explanation •Abdominal pain, bloating, nausea, erratic bowel habit, early satiety etc.....

2

rome 3 classification?

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3

rome 3 ibd criteria?

Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months that has two or more of the following features: –Improved with defæcation –Onset associated with a change in frequency  –Onset associated with a change in form

4

abcd of ibs?

Abdominal Pain •Bloating •Constipation •Diarrhoea

5

rome 3 criteria of functional dyspepsia?

One or more of: –Bothersome postprandial fullness –Early satiation –Epigastric pain –Epigastric burning AND •No evidence of organic disease (including at upper endoscopy) that is likely to explain the symptoms

6

ibs extra intestinal symptoms?

tiredness, back pain, bad breath

7

list of medically unexplained symptoms?

Irritable Bowel Syndrome •Fibromyalgia •Chronic fatigue Syndrome •Irritable Bladder Syndrome •Tinnitus •Non-inflammatory pelvic pain  etc.

8

proposed mechanism?

Altered intestinal motility – ‘spasm’ •Visceral hypersensitivity (normal & abnormal GI events) •Altered CNS perception of visceral events •Psychological factors •Previous intestinal infection

9

psychological factors?

Stress influences GI function/symptoms  •Psychological disorders can give GI complaints •Stress may trigger & exacerbate IBS symptoms - increased prevalence anxiety/ depression •No specific profile of personality that is unique to IBS

10

differential diagnosis?

Cancer – (Gastric/Oesophageal Pancreatic/Gynae. etc) •Peptic ulcers •G-O reflux •Cardiac / pleuritic pain •Gallstones •Pancreatitis  •Coeliac disease  •Lactose intolerance  •Infection •Ulcerative colitis •Crohn’s Disease •Intestinal ischaemia •Diverticulosis •Endometriosis •Thyroid disease •Hypo/hyper calcaemia •Drugs •Psychiatric disorders

11

investigations?

Can diagnose FGID’s with established criteria & limited exclusion of organic (structural, metabolic, infectious) diseases •Detailed assessment of symptoms •Physical examination – (can have bloating/tenderness) •Further tests – blood / stool (C&S, Calprotectin), endoscopy, radiology

12

symptoms of organic disease?

New onset older age  •Pain that interferes with normal sleep  •Diarrhoea during night / Steatorrhoea   •Visible / occult blood in the stool  •Weight loss  •Fever

13

lab features?

Elevated ESR / CRP •Anaemia / ↑ WBC or Platelets  •Hypokalaemia / Hypoalbuminaemia  •Blood, pus or fat in the stool •Stool weight >200g/day •Persistent diarrhoea during 48hr fast

14

drug options?

Laxatives  •Antidiarrhoeals •Antiemetics •Antispasmodics   •Anticholinergics •Antidepressants Ispaghula husk Lactulose/ MgOH Loperamide Domperidone Peppermint oil Mebeverine Hyoscine Amitriptyline

15

serotonin & the gi?

5 HT3 antagonists (eg Alensetron) inhibit motility  – colonic transit time (excess water absorption) – intestinal secretion •5 HT4 agonists  (eg Prucalopride) stimulate motility –  increase gastric emptying –  peristalsis –  colonic activity ( small bowel transit time)

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