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07. Year 2: Alimentary System > Functional Bowel Disorders > Flashcards

Functional Bowel Disorders Flashcards

1
Q

What are the 2 broad categories of GI disease?

A

Structural

Functional

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2
Q

What is the difference between structural and functional GI disease?

A

Structural has detectable pathology whereas functional does not

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3
Q

What are examples of functional GI disorders?

A

Oesophageal spasm

Non-ulcer dyspepsia (NUD)

Biliary dyskinesia

Irritable bowel syndrome

Slow transit constipation

Drug related effects

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4
Q

What does NUD stand for?

A

Non-ulcer dyspepsia

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5
Q

What do functional GI disorders have a large impact on?

A

Quality of life

Psychological factors

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6
Q

What are functional GI disorders not associated with that structural disorders are?

A

Serious pathology

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7
Q

What is non-ulcer dyspepsia?

A

Chronic or recurrent abdominal pain or nausea, without an ulcer

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8
Q

What is the helicobacter pylori status of non-ulcer dyspepsia?

A

It varies

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9
Q

What diseases i non-ulcer dyspepsia probably a combination of?

A

Reflux

Low grade duodenal ulceration

Delayed gastric emptying

Irritable bowel syndrome

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10
Q

What does the diagnosis of non-ulcer dyspepsia involve?

A

Careful history and examination - FH is important

H Pylori status

Alarm symptoms

If in doubt, endoscopy

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11
Q

What therapy is required for non-ulcer dyspepsia when H Pylori is positive?

A

Eradication therapy

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12
Q

What is nausea?

A

The sensation of feeling sick

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13
Q

What is retching?

A

Dry heaves (antrum contracts, glottis closed)

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14
Q

What is vomiting?

A

Abdominal contents expelled

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15
Q

What is often found in the history of nausea and vomiting immediately, 1 hour or more, 12 hours?

A

Immediate cause is psychogenic

1 hour or more is due to pyloric obstruction or motility disorders (diabetes, post gastrectomy)

12 hours or more is obstruction

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16
Q

What are some functional causes of nausea and vomiting?

A

Drugs

Pregnancy

Migraine

Cyclical vomiting syndrome

Alcohol

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17
Q

What is psychogenic vomiting?

A

Vomiting without any obvious organ pathology or with a psychological aetiology

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18
Q

Who often suffers from psychogenic vomiting?

A

Young woman

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19
Q

What often happens to psychogenic vomiting after admission?

A

It stops

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20
Q

What is irritable bowel syndrome?

A

Condition of the digestive system that can cause crampls, bloating, diarrhoea and constipation

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21
Q

What is slow transit constipation?

A

Reduced motility of the large intestine caused by abnormalities of the enteric nerves

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22
Q

How does bowel habit from person to person vary?

A

There is a great variation in both bowel habit and stool weight

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23
Q

What is the average stool weight in the UK?

A

100-200g/day

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24
Q

What should be known about the interpretation of the word constipation?

A

It means different things to different people, so a better approach is to ask the patient about changes in the frequency, consistency, presence of blood or mucus from there normal

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25
Q

What are alarm symptoms relating to constipation?

A

Age >50 years

Short symptoms history

Unintentional weight loss

Nocturnal symptoms

Male sex

Family history of bowel/ovarian cancer

Anaemia

Rectal bleeding

Recent antibiotic use

Abdominal mass

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26
Q

What investigations should be done for slow transit constipation?

A

Colonoscopy

FBC

Blood glucose

U + E

Thyroid status

Coeliac serology

FIT testing

Sigmoidoscopy

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27
Q

What are different categories of the aetiology of constipation?

A

Systemic

Neurogenic

Organic

Functional

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28
Q

What are examples of systemic causes of constipation?

A

Diabetes mellitus

Hypothyroidism

Hypercalcaemia

29
Q

What are examples of neurogenic causes of constipation?

A

Autonomic neuropathies

Parkinson disease

Strokes

Multiple sclerosis

Spina bifida

30
Q

What are examples of organic causes of constipation?

A

Strictures

Tumours

Diverticular diseases

Proctisis

Anal fissure

31
Q

What are examples of functional causes of constipation?

A

Megacolon

Idiopathic constipation

Depression

Psychosis

Institutionalised patients

32
Q

What are clinical features of irritable bowel syndrome?

A

Abdominal pain

Altered bowel habit

Abdominal bleeding

Belching wind and flatus

Mucus

33
Q

What does IBS stand for?

A

Irritable bowel syndrome

34
Q

What do NICE guidelines say is required to diagnose irritable bowel syndrome?

A

Abdominal pain/discomfort relieved by defaecation or association with altered stool frequency/form plus two or more of:

altered stool passage

abdominal bloating/distension

symptoms made worse by eating

passage of mucus

35
Q

What can be said about abdominal pain for IBS?

A

Very variable

36
Q

What are different kinds of abdominal pain that can be felt with IBS?

A

Vague

Bloating

Burning

Sharp

37
Q

Does abdominal pain due to IBS ever radiate?

A

Occasionally, often to the lower back

38
Q

What are some examples of altered bowel habit for IBS?

A

Constipation (IBS-C)

Diarrhoea (IBS-D)

Both diarrhoea and constipation (IBS-M)

Variability

Urgency

39
Q

What symptoms often coincide with bloating?

A

Wind and flatulence

Relaxation of abdominal wall muscles

Mucus in stool

40
Q

What is the physical examination for IBS like?

A

Normal

41
Q

What investigations are done for IBS?

A

Blood analysis

Stool culture

Calprotectin

FIT testing

42
Q

What causes calprotectin to be released?

A

Inflamed gut

43
Q

What is calprotectin used to differentiate?

A

IBS from IBD, and to monitor IBD

44
Q

What is the treatment for IBS?

A

Education and reassurance

Dietetic review

45
Q

What is discussed in a dietetic review for IBS?

A

Tea, coffee, alcohol, sweetener

Lactose, gluten exclusion trial

FODMAP

46
Q

What is the FODMAPS diet?

A

Excess fructose

Lactose

Fructans

Galactans

Polyols

47
Q

What drug therapy is given for pain due to IBS?

A

Antispasmodics

Linaclotide (IBS-C)

Antidepressants

48
Q

What drug therapy is given for bloating due to IBS?

A

Some probiotics

Linaclotide (IBS-C)

49
Q

What drug therapy is given for constipaition due to IBS?

A

Laxatives

Linaclotide

50
Q

What drug therapy is given for diarrhoea due to IBS?

A

Antimotility agents

FODMAP diet

51
Q

What psychological interventions can be done for IBS?

A

Relaxation training

Hypnotherapy

Cognitive behavioural therapy

Psychodynamic interpersonal therapy

52
Q

What patients should get relaxation training for IBS?

A

Patients with diarrhoea and psychological comorbidity

53
Q

What is the mode of action of relaxation training?

A

Uses progressive muscle relaxation, biofeedback and meditation for stress relief

54
Q

What is the mode of action for hypotherapy?

A

Hypnosis induces a state of deep relaxation

55
Q

What patients with ISB should receive hypnosis?

A

Refractory patients with pain, constipation, flatulence or anxiety

56
Q

What is flatulence?

A

Build up of gas in the digestive system that leads to abdominal discomfort

57
Q

What is the mode of action of cognitive behavioural therapy?

A

Involves identifying symptom triggers and learning to respond more appropriately

58
Q

What patients with IBS is cognitive behaviour therapy useful for?

A

Ones with abdominal pain, bloating or flatulence

59
Q

What patients with IBS is cognitive behaviour therapy not effective for?

A

Ones with depression or when patients believe in a physical cause for their symptoms

60
Q

What is the mode of action of psychodynamic interpersonal therapy?

A

Helps the patient to understand how emotions and bowel syndromes interrelate

61
Q

What patients with IBS is psychodynamic interpersonal therapy useful for?

A

Patients with a history of abuse

62
Q

What patients with IBS is psychodynamic interpersonal therapy not useful for?

A

Patients with constipation, constant pain or depression

63
Q

What causes IBS?

A

Altered motility

Visceral hypersensitivity

Stress, anxiety, depression

64
Q

In simple terms, what is the bowel?

A

A muscular tube that squeezes content from one end to the oyther

65
Q

In what form of IBS are muscular contractions of the bowel stronger, and what form are they weaker?

A

In IBS-D muscular contractions may be stronger

In IBS-C contractions may be reduced

66
Q

What is an example of gut response triggers being altered in IBS?

A

Contractions can be triggered by walking and eating

67
Q

What is the awareness of someones gut who has IBS like?

A

Excessive awareness of normal digestive processes, which most people do not feel

68
Q

How is the sensitivity of the gut due to stress in IBS different from normal?

A

The gut is more sensitive

69
Q

What can be said about mortality and qualitiy of life of functional GI problems?

A

Low mortality

High impact on quality of life

07. Year 2: Alimentary System (41 decks)

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