Functional GI disorders

Question 1

What are the 2 types of GI disease?

Answer 1

Structural

Functional

Question 2

What is a structural GI disease?

Answer 2

Detectable pathology, either macro or microscopic

Question 3

What is an example of a macro and microscopic structural pathology?

Answer 3

Macro= cancer
Micro= colitis

Question 4

What is functional GI disease?

Answer 4

Structure is normal and there is no detectable pathology, but function is not working

Question 5

What is non ulcer dyspepsia?

Answer 5

Dyspepsic type pain but no ulcer on endoscopy

Not a single disease, covers a range of things

Question 6

What disorders does the term non ulcer dyspepsia cover?

Answer 6

Reflux
Low grade duodenal ulceration
Delayed gastric emptying
IBS

Question 7

How is non ulcer dyspepsia diagnosed?

Answer 7

History and exam

If in doubt, endoscopy

Question 8

How is non ulcer dyspepsia treated?

Answer 8

Symptomatically

Eradication of H pylori if necessary

Question 9

How is vomiting controlled?

Answer 9

Vomiting centre

Chemoreceptor trigger zone

Question 10

What can activate the chemoreceptor trigger zone of the vomiting centre?

Answer 10

Opiates
Digoxin
Chemotherapy
Iraemia

Question 11

What does immediate vomiting after eating suggest?

Answer 11

Psychogenic disorder

Question 12

What does vomiting 1 or more hours after eating suggest?

Answer 12

Pyloric obstruction

Motility disorders

Question 13

What does vomiting 12 or more hours after eating suggest?

Answer 13

Obstruction of small intestine

Question 14

What are the functional causes of vomiting?

Answer 14

Drugs
Pregnancy
Migraine
Cyclical vomiting syndrome
Alcohol

Question 15

What is cyclical vomiting syndrome?

Answer 15

Recurrent episodes of severe vomiting for 2-3 days from several times a year to several times a month

Question 16

What are some features of psychogenic vomiting?

Answer 16

Mainly young women
May have no preceding nausea or appetite change
May be self induced, may cause weight loss
Often stops soon after admission

Question 17

What signs and symptoms would cause alarm when paired with a change in stool?

Answer 17

Age, anaemia, abode mass, antibiotic use
Family history
Loss of weight
Male
Nocturnal symptoms
Rectal bleeding
Short symptom history

Question 18

What investigations are done in everyone who has had a change in stool?

Answer 18

FBC
Blood glucose
U+E
Thyroid
Coeliac serology

Question 19

What are the 4 causes of constipation?

Answer 19

Systemic
Neurogenic
Organic
Functional

Question 20

What are the systemic causes of constipation?

Answer 20

Diabetes mellitus
Hypothyroidism
Hypercalcaemia

Question 21

What are the neurogenic causes of constipation?

Answer 21

Autonomic neuropathies
Parkinson's
Stroke
MS
Spina bifida

Question 22

What are the organic causes of constipation?

Answer 22

Strictures
Tumours
Diverticular disease
Proctitis
Anal fissure

Question 23

What are the functional causes of constipation?

Answer 23

Megacolon
Idiopathic constipation
Depression
Psychosis
Institutionalised patients

Question 24

What are the clinical features of IBS?

Answer 24

Abdo pain
Altered bowel habit
Abdo bloating

Question 25

What are the features of IBS pain?

Answer 25

Occasionally radiates, mainly to lower back Often improved by bowel action Rarely at night

Question 26

What are the types of changes in bowel habit we look for in IBS?

Answer 26

``` Constipation Diarrhoea Both Variability Urgency ```

Question 27

How is IBS diagnosed?

Answer 27

Compatible history | Normal physical examination

Question 28

What investigations can be done for IBS?

Answer 28

``` Blood analysis Stool culture Calprotectin Possible rectal exam and FOB Colonoscopy if there are concerning features? ```

Question 29

How is IBS treated?

Answer 29

Education and reassurance Dietetic review Drug therapy Psychological intervention

Question 30

What drugs can be used for pain in IBS?

Answer 30

Antispasmodics IBS-C- linaclotide and SSRIs IBS-D- TCA antidepressants

Question 31

What drugs can be used for bloating in IBS?

Answer 31

Probiotics | IBS-C- linaclotide

Question 32

What drugs can be used for constipation in IBS?

Answer 32

Laxatives | Linaclotides

Question 33

What drugs can used for diarrhoea in IBS?

Answer 33

Antimotiloty agents

Question 34

What psychological interventions can be used in IBS?

Answer 34

Relaxation therapy Hypnotherapy Cognitive behavioural therapy Psychodynamic therapy

Question 35

What is the cause of IBS?

Answer 35

Altered motility Visceral hypersensitivity Stress, anxiety, depression

Question 36

What happens in IBSD?

Answer 36

Bowel contractions stronger and more frequent | Response to gut triggers stronger

Question 37

What happens in IBSC?

Answer 37

Bowel contractions reduced | Response to gut triggers weaker