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Family medicine > GI disorders > Flashcards

GI disorders Flashcards

1
Q

What is dyspepsia?

A

Indigestion - meaning heard/ difficult digestion. Is a medical condition characterized by 1) chronic/ recurrent pain in the upper abdomen 2) upper and fullness 3) feeling full earlier than expected

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2
Q

What are the reasons for encounter in primary care w dyspepsia?

A
  • Fear from cancer
  • Need for reassurance
  • Fear from HD
  • family history
  • just feeling bad
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3
Q

What is the GP perspective, rather label than disease in dyspepsia (?)

A
  • Severity of symptoms
  • frequence of symptoms
  • fréquence of visits
  • psychological aspect, tx or investigation as a problem solution
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4
Q

What is the etiology of dyspepsia?

A

Cause and effect difficult to establish

  • sx are intermittent and changing
  • high placebo response rate
  • no specific findings in all patients present (?)
  • findings present in asymptomatic pat as well (?)
  • sx and findings often do not correlate
  • there is no universal effective tx
  • response to tx is difficult to predict
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5
Q

What are the causes of dyspepsia?

A
  • Reflux esophagitis 12%
  • duodenal ulcer 10%
  • gastric ulcer 6%
  • gastric carcinoma 1%
  • esophageal carcinoma 0,5%
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6
Q

What is the first approach in dyspepsia?

A
  • Consider possible causes outside upper GI tract (heart, lung, liver, GB, pancreas, bowel(?))
  • Consider drugs and stop if possible (aspirin, NSAIDs, calcium antagonist, nitrates, theophylline, etidronate, steroids)
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7
Q

What are the alarm sx in dyspepsia?

A
  • GI bleed, same day referral
  • persistent vomiting
  • weight loss, progressive unintentional
  • dysphagia
  • epigastric mass
  • anemia due to possble GI loss
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8
Q

What should all pat w new onset dyspepsia have?

A

Abdominal examination and FBC

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9
Q

What is the Rome IV criteria?

A

An international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia and rumination syndrome.

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10
Q

What is the Rome IV B1 criteria for dyspepsia?

A
  1. One or more of the following:
    a) bothersome postprandial fullness
    b) bothersome early satiation
    c) bothersome epigastric pain
    d) bothersome epigastric burning
  2. No evidence of structural disease, including upper endoscopy, that is likely to explain the sx

Criteria should be fulfilled for the last three months w sx onset at least 6 months before Dx

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11
Q

What is the B1a postprandial distress sd criteria?

A

Must include 1 or both of the following at least 3d x week

  1. Bothersome postprandial fullness (sever enough to impact on usual activity)
  2. Bothersome early satiation ( severe enough to prevent finish a regular size meal)
    - No evidence of organic, systemic or metabolic disease that is likely to explain Sx on routine investigation (ES)
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12
Q

What are the supportive remarks to B1a postprandial distress sd?

A
  • Post prandial epigastric pain, burning, bloating, excessive belching and nausea
  • Vomiting warrants consideration of another disorder
  • Heartburn is not a dyspeptic sx but may often coexist
  • Sx that are relieved by evacuation of feces or gas should generally not be considered as a part of dyspepsia
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13
Q

B1b Epigastric pain sd rome criteria

A
  • Must include at least one of the following Sx at least 1 d a week
    1. Bothersome epigastric pain ( severe enough to impact usual activities)
    AND/OR
    2. Bothersome epigastric burning ( severe enough to impact on usual activities)
  • No evidence of organic, systemic, or metabolic disease that is likely to explain the sx on routine examination
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14
Q

What are the supportive remarks about B1b epigastric pain sd?

A
  • Induced by ingestion of meal, relieved by ingestion of meal or may occur while fasting
  • Postprandial epigastric bloating, belching and nausea
  • Vomiting suggest other dx
  • heartburn is not a sx but may be present
  • Pain does not fulfill biliary pain criteria
  • sx that decrease by feces and gas should not be considered a part of dyspepsia
  • other digestive sx may coexist w EPS
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15
Q

What is the mx of dyspepsia < 45y?

A
  • Explain benign nature of dyspepsia
  • Lifestyle change: healthy diet, weight reduction, stop smoking, use of antacid
  • Epigastric pain: 1) Antidepressant (TCA) 2) test and treat H.pylori and/or 3) empiric PPI 4) lifestyle advice
  • postprandial distress: 1) antidepressant (TCA, Buspirone, mirtazepine) 2) prokinetics eg acotiamide 3) antiemetics if nausea 4) poistive dx, lifestyle
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16
Q

What is the 3 most common causes of abdominal pain in hospitalized elderly?

A
  • Acute cholecystitis 26%
  • Malignancy 13%
  • Bowel obstruction 11%
17
Q

What is irritable bowel syndrome? (IBS)

A

Functional GI disorder characterized by abd pain and altered bowel habits in the absence of a specific and unique organic pathology ( although microscopic inflammation has been documented in some pat)

18
Q

What is the risk factors for IBS?

A
  • Pathological stress
  • Genetic
  • Early life experience
  • Infection, surgery, ABs
19
Q

What is involved in the pathugenesis/ pathophysiology of IBS?

A
  • Early family environment, adverse life events, chronic stress, psychosocial factors
  • Gentic predisposition
  • food
  • GI infection and inflammation, GI bacterial flora
  • Altered intestinal barrier (?)
  • Abnormal GI motility
  • Visceral hypersensitivity
  • CNS, autonomic nervous system (ANS) , spinal pathways (gut-brain-gut axis), enteric nervous system (ENS)
  • Perpetuating factors: symptomatic related anxiety
20
Q

What is the Dx criteria for IBS?

A
  • Recurrent abd pain on average at least 1 day per week in last 3 months, ass w 2 or more of the following:
    1. Related to defecation
    2. Ass w change in frequency of stool
    3. Ass w change in form of stool
  • Criteria for at least 3 months w symptoms onset at least 6 months prior to dx
21
Q

What are the manifestations of IBS?

A
  • Altered bowel habits
  • Abdominal pain
  • Abdominal bloating / distention
22
Q

Altered bowel habits in IBS have the following characteristics:

A
  • Constipation w variability of hard stool / narrow caliber, painful / infrequent defecation and intractability to laxatives
  • Diarrhea: small volumes of loose stool w evacuation preceded by urgency and frequent defecation
  • Postprandial urgency is common, as is alteration btw constipation and diarrhea
  • Characteristically one feature generally predominate in a pat w variability among them
23
Q

What is bristol chart?

A

Classify human feces into seven categories

  • Type 1 is separate hard lumps
  • Type 7 is watery w no solid pieces, entirely liquid
24
Q

How is the abd pain in IBS

A
  • Diffuse w/o radiation
  • Common site: lower abd, esp LLQ
  • Acute episode of sharp pain are often superimposed on a more constant dull ache
  • meals may precipitate pain
  • defecation commonly improve pain but may not fully relieve it
25
Q

What are the additional sx in IBS?

A
  • Clear/ white mucorhea of a noninflammatory etiology
  • Dyspepsia /heartburn
  • N/V
  • sexual dysfunction (incl dyspareunia and poor libido)
  • urinary frequency and urgency
  • worsening sx in perimentrual period
  • comorbid fibromyalgia
  • stressor related sx
26
Q

What sx are not consistent w IBS and may suggest organic pathology?

A
  • onset middle age or older
  • acute sx
  • progressive sx
  • nocturnal sx
  • anorexia/ weight loss
  • fever
  • rectal bleeding
  • painless diarrhea
  • steathorea
  • gluten intolerance
  • family history w colorectal cancer, IBD or celiac
27
Q

What are supportive sx of IBS?

A
  • altered frequency
  • stool form altered
  • altered stool passage (straining and/or urgency)
  • muchorhea
  • abd bloating or subjective distention
28
Q

How can you classify IBS

A

IBS-D: diarrhea is predominant
IBS-C: constipation is predominant
IBS-M: mixed diarrhea and constipation
IBS-U: unclassified, cannot be in categories above

29
Q

What should you use to screen for and rule out other disease?

A
  • FBC, ESR, CRP = anemia, infection and inflammation
  • metabolic panel
  • stool examination: ova, parasite, pathogens, leukocytes, C.diff, Giardia
  • hydrogen breath test: exclude bacterial overgrowth
  • tissue transglutaminase and small bowel biopsy (celiac)
  • thyroid function test
  • serum Ca, hyperparathyroidism
30
Q

What are used to dx IBS?

A
  • clinical history + criteria
  • physical examination
  • minimal lab tests
  • colonoscopy + biopsy when indicated
31
Q

What is the Mx of IBS

A
  • Diet
  • Anticholenrgics: dicyclomine, hyoscymine
  • Antidiarrheals: diphenoxylate, looperamide
  • TCA: imipramine, amitryptiline
  • Bulk forming laxatives
  • Serotonin receptor antagonists (alosetron)
  • Antispasmodics: peppermint oil, trimebutine
  • Rifaxamin
32
Q

What is the dietary adivice w IBS?

A
  • Fiber supplementation
  • Polycarbophil
  • Water intake
  • Caffeine avoidance
  • legume avoidance
  • probiotics
  • FODMAP
33
Q

What is FODMAP?

A 
FODMAP is food that should be avoided. (lactose, fructose) 
Fermentable 
Oligosaccharide
Disaccharide
Monosaccharide 
And
Polyols
34
Q

What is the SE of antispasmodics?

A
  • May be effective for postprandial pain but not chronic pain
  • Dry mouth
  • Vision disturbance
  • Constipation
  • Urinary retention

Family medicine (14 decks)

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