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Flashcards in Functional GI Disorders Deck (42)
1

What are the two broad categories of GI disease?

Structural and Functional

2

What is structural GI disease?

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

3

What is functional GI disease?

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

4

List some functional GI disorders

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

5

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

6

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

7

What is nausea?

Sensation of feeling sick

8

What is retching?

Dry heaves
Antrum contracts but glottis closed

9

What is Vomiting?

GI tract contents expelled

10

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

11

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)

12

What are the functional causes of vomiting?

Drugs
Pregnancy
Migraine
Cyclical Vomiting Syndrome
Alcohol

13

What is cyclical vomiting syndrome?

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

14

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

15

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

Irritable bowel syndrome
Slow transit constipation

16

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

17

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

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

18

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

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

19

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

20

What is the aetiology of constipation?

Systemic
Neurogenic
Organic
Functional

21

What are some of the organic aetiologies of of constipation?

Strictures
Tumours
Diverticular disease
Proctitis
Anal fissue

22

What are some of the functional aetiologies of constipation?

Megacolon
Ideopathic constipation
Depression
Psychosis
Institutionalised patients

23

What are some of the systemic causes of constipation?

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

24

What are some of the Neurogenic causes of constipation?

Autonomic Neuropathies
Parkinson's disease
Strokes
Multiple sclerosis
Spina bifida

25

what are the clinical features of IBS?

Abdominal pain
Altered Bowel habit
Abdominal bloating

Belching wind and flatus
Mucous

26

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

27

What is the abdominal pain in IBS like?

Vary variable
-Vague
-Bloating
-Burning
-Sharp

Occasionally radiated often to lower back
(So does IBD...)

28

what do we mean with altered bowel habit in IBS?

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

29

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

30

What two things are requires of a diagnosis of IBS?

A compatible history
Normal physical examination

31

What are the investigations for IBS?

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

Stool Culture

Calprotectin

32

How should CRP differentiate between IBS and IBD?

CRP should be normal in IBS and raised in IBD

33

What is calprotectin?

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

Used for monitoring in IBD

34

What dietetic review can be carried out in IBS patients?

Tea, coffee, alcohol, sweetener (laxatives)

Lactose, gluten exclusion trial

FODMAP

35

What is FODMAP

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

36

What is the drug therapy for pain in IBS?

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

37

What is the treatment for bloating in IBS?

Some probiotics
Linaclotide (IBS-C)

Avoid
-Bulking agents/ fibre

38

What is the treatment for constipation in IBS?

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

Avoid
-TCAs
-FODMAP

39

What is the drug therapy for diarrhoea in IBS?

Anti motility agents
FODMAP

Avoid SSRIs

40

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

41

What 3 things cause IBS?

Altered motility
Visceral hypersensitivity
Stress, anxiety, depression

42

What do we mean by heightened gut awareness in IBS?

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