Flashcards in Functional GI Disorders Deck (42)
What are the two broad categories of GI disease?
Structural and Functional
What is structural GI disease?
-Macroscopic (e.g cancer)
-Microscopic (e.g. Colitis)
Prognosis depends on pathology
What is functional GI disease?
No detectable pathology
Related to gut function
Long-term prognosis good
List some functional GI disorders
Non-Ulcer Dysplasia (NUD)
Irritable Bowel Syndrome
Slow Transit Constipation
Drug Related Effects
What is Non-Ulcer Dyspepsia?
Dyspeptic type pain
No Ulcer on endoscopy
Probably not a single disease
-Low grade duodenal ulceration
-Delayed Gastric emptying
-Irritable bowel syndrome
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
What is nausea?
Sensation of feeling sick
What is retching?
Antrum contracts but glottis closed
What is Vomiting?
GI tract contents expelled
What are the sympathetic and Vagal components of vomiting?
Vomiting centre (may not exist as entity)
Chemoreceptor trigger zone
-Receptors for opiates
How do you take a history of vomiting?
LENGTH OF TIME AFTER FOOD:
-One hour or more
(pyloric obstruction, motility disorders such as diabetes or post gastrectomy)
-12 Hours (obstruction etc)
What are the functional causes of vomiting?
Cyclical Vomiting Syndrome
What is cyclical vomiting syndrome?
Onset often in childhood
Recurrent episodes of heavy vomiting
2-3 times a year up to times a month
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
what are two common functional diseases of the lower GI tract?
Irritable bowel syndrome
Slow transit constipation
What is important to bare in mind about bowel habit?
Ask the patient:
What is normal?
What has changed?
Disease of the lower GI tract should include what in its examination?
Look for systemic disease
Careful abdominal examination
Rectal exam if needed
What are the investigations for change in bowel habit with constipation?
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?
What are some of the organic aetiologies of of constipation?
What are some of the functional aetiologies of constipation?
What are some of the systemic causes of constipation?
What are some of the Neurogenic causes of constipation?
what are the clinical features of IBS?
Altered Bowel habit
Belching wind and flatus
What is the Rome criteria for IBS?
-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
What is the abdominal pain in IBS like?
Occasionally radiated often to lower back
(So does IBD...)
what do we mean with altered bowel habit in IBS?
Both diarrhoea and constipation (IBS-M)
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?
-U+E, LFT, Ca
-TFTs (thyroid function tests)
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
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?
What is the treatment for bloating in IBS?
-Bulking agents/ fibre
What is the treatment for constipation in IBS?
-Bulking agents/fibre (episodic)
What is the drug therapy for diarrhoea in IBS?
Anti motility agents
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?
Stress, anxiety, depression