Functional GI Disorders Flashcards by Andrew Hay

What are the two broad categories of GI disease?

Structural and Functional

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What is structural GI disease?

Detectable pathology
-Macroscopic (e.g cancer)
-Microscopic (e.g. Colitis)
Usually both
Prognosis depends on pathology

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What is functional GI disease?

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

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List some functional GI disorders

Oesophagel spasm
Non-Ulcer Dysplasia (NUD)
Biliary Dyskinesia
Irritable Bowel Syndrome
Slow Transit Constipation
Drug Related Effects

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What is Non-Ulcer Dyspepsia?

Dyspeptic type pain
No Ulcer on endoscopy
Probably not a single disease
-Reflux
-Low grade duodenal ulceration
-Delayed Gastric emptying
-Irritable bowel syndrome

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How do you diagnose Non-Ulcer Dyspepsia?

Careful history and examination

Gastric cancer? (rare in under 45s)

H. Pylori status? ->eradication

Alarm symptoms? (unexplained weightloss, vomiting)

If doubt: endoscopy

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What is nausea?

Sensation of feeling sick

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What is retching?

Dry heaves

Antrum contracts but glottis closed

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What is Vomiting?

GI tract contents expelled

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What are the sympathetic and Vagal components of vomiting?

Vomiting centre (may not exist as entity)

Chemoreceptor trigger zone

Receptors for opiates
Digoxin
Chemotherapy
Uraemia

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How do you take a history of vomiting?

LENGTH OF TIME AFTER FOOD:
-Immediate (psychogenic)
-One hour or more 
(pyloric obstruction, motility disorders such as diabetes or post gastrectomy)
-12 Hours (obstruction etc)

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What are the functional causes of vomiting?

Drugs
Pregnancy
Migraine
Cyclical Vomiting Syndrome
Alcohol

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What is cyclical vomiting syndrome?

Onset often in childhood
Recurrent episodes of heavy vomiting
2-3 times a year up to times a month

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What is psychogenic vomiting?

Vomits as soon as they are sick

Often young woman
Often for years
may have no preceding nausea
May be self induced (overlap with bulimia)
Appetite usually not disturbed but may lose weight
Often stops soon after admission

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what are two common functional diseases of the lower GI tract?

Irritable bowel syndrome

Slow transit constipation

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What is important to bare in mind about bowel habit?

Great variation.

Ask the patient: 
What is normal? 
What has changed?
-Frequency
-Consistency
-Blood
-Mucous

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Disease of the lower GI tract should include what in its examination?

Look for systemic disease
Careful abdominal examination
Rectal exam if needed
FOB

What are the investigations for change in bowel habit with constipation?

FBC
Blood glucose
U+E
Thyroid status
Coeliac serology
Proctoscopy
Sigmoidoscopy
COLONOSCOPY

What is the different approach you should take to fresh blood and dark red blood in the stool?

Fresh blood is common. Take in context

Dark blood is usually worth investigating

What is the aetiology of constipation?

Systemic
Neurogenic
Organic
Functional

What are some of the organic aetiologies of of constipation?

Strictures
Tumours
Diverticular disease
Proctitis
Anal fissue

What are some of the functional aetiologies of constipation?

Megacolon
Ideopathic constipation
Depression
Psychosis
Institutionalised patients

What are some of the systemic causes of constipation?

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

What are some of the Neurogenic causes of constipation?

Autonomic Neuropathies
Parkinson's disease
Strokes
Multiple sclerosis
Spina bifida

what are the clinical features of IBS?

Abdominal pain Altered Bowel habit Abdominal bloating Belching wind and flatus Mucous

What is the Rome criteria for IBS?

Abdominal pain: - Relieved by defaeation - Associated with change of frequency - Associated change of consistency AND (2 or more) - Altered stool frequency - Altered stool form - Altered stool passage - Passgae of mucous - Bloating

What is the abdominal pain in IBS like?

Vary variable - Vague - Bloating - Burning - Sharp Occasionally radiated often to lower back (So does IBD...)

what do we mean with altered bowel habit in IBS?

``` Constipation (IBS-C) Diarrhoea (IBS-D) Both diarrhoea and constipation (IBS-M) Variability Urgency ```

What is the bloating in IBS like?

``` Often very prominent Wind and flatulence Relaxation of abdominal muscles Mucous in stool Upper and other GI symptoms ```

What two things are requires of a diagnosis of IBS?

A compatible history | Normal physical examination

What are the investigations for IBS?

Blood analysis - FBC - U+E, LFT, Ca - CRP - TFTs (thyroid function tests) - Coeliac serology Stool Culture Calprotectin

How should CRP differentiate between IBS and IBD?

CRP should be normal in IBS and raised in IBD

What is calprotectin?

Protein released by inflamed mucosa Detected in stool Used for DIFFERENTIATING IBS from IBD Used for monitoring in IBD

What dietetic review can be carried out in IBS patients?

Tea, coffee, alcohol, sweetener (laxatives) Lactose, gluten exclusion trial FODMAP

What is FODMAP

Exclusion diet to work out if any of the items involved cause symptoms

What is the drug therapy for pain in IBS?

Pain - Linaclotide (IBS-C) - Antidepressents - TCAs (IBS-D) - SSRIs (IBS-C)

What is the treatment for bloating in IBS?

Some probiotics Linaclotide (IBS-C) Avoid -Bulking agents/ fibre

What is the treatment for constipation in IBS?

``` Laxatives -Bulking agents/fibre (episodic) -Softeners (adjuvant) -Stimulants (occasionally) -Osmotics (regular) Linoclotide ``` Avoid - TCAs - FODMAP

What is the drug therapy for diarrhoea in IBS?

Anti motility agents FODMAP Avoid SSRIs

How do the contractions of the bowel differ in IBS-C and IBS-D?

IBS-D contractions may be stronger and more frequent In IBS-C contractions may be reduced

What 3 things cause IBS?

Altered motility Visceral hypersensitivity Stress, anxiety, depression

What do we mean by heightened gut awareness in IBS?

People with IBS often have an excessive awareness of normal digestive processes