Functional bowel disorders

Question 1

Define functional bowel disorders

Answer 1

Diseases with no obvious pathology, related to gut function

Question 2

Give some examples of functional bowel disorders

Answer 2

o	Oesophageal spasm
o	Non-Ulcer Dyspepsia (NUD)
o	Biliary Dyskinesia
o	Irritable Bowel syndrome
o	Slow Transit Constipation
o	Drug Related Effects

Question 3

What other diseases can be involved in non-ulcer dyspepsia to cause symptoms?

Answer 3

o Reflux
o Low grade duodenal ulceration
o Delayed Gastric emptying
o Irritable bowel syndrome

Question 4

What are the ALARM(s) symptoms for endoscopy?

Answer 4

Anaemia
Loss of weight
Anorexia
Recent onset of symptoms/over 55yo
Melaena, masses or haematemesis
Swallowing difficulty

Question 5

What controls vomiting?

Answer 5

Chemoreceptor Trigger Zone (CTZ)

Question 6

What drugs can affect the chemoreceptor trigger zone?

Answer 6

• Receptors for opiates
• Digoxin
• Chemotherapy
• Uraemia in renal failure – severe nausea

Question 7

How long after eating before vomiting would suggest psychogenic vomiting?

Answer 7

Immediately after eating

Question 8

How long after eating before vomiting would suggest pyloric obstruction or a motility disorder?

Answer 8

1 hour

Question 9

How long after eating before vomiting would suggest obstruction by hernias or strictures?

Answer 9

12 hours

Question 10

What are some functional causes of vomiting?

Answer 10

• Drugs
• Pregnancy
• Migraine (abdominal migraine, aura)
• Cyclical Vomiting Syndrome (quite rare)
• Alcohol

Question 11

What are some functional diseases of the lower GI tract?

Answer 11

• Irritable Bowel Syndrome

* Slow Transit Constipation

Question 12

What systemic diseases are associated with constipation?

Answer 12

o Diabetes mellitus
o Hypothyroidism
o Hypercalcaemia

Question 13

What neurogenic diseases are associated with constipation?

Answer 13

o	Autonomic neuropathies
o	Parkinson's disease
o	Strokes
o	Multiple sclerosis
o	Spina bifida

Question 14

What organic diseases can cause constipation?

Answer 14

o	Strictures
o	Tumours
o	Diverticular disease - pouches in gut
o	Proctitis
o	Anal fissure

Question 15

What are the two classification systems for IBS?

Answer 15

ROME III

NICE

Question 16

What are the three types of IBS?

Answer 16

• Constipation predominant (IBS-C)
• Diarrhoea predominant (IBS-D)
• Both diarrhoea and constipation treatment (IBS-M)

Question 17

What are the clinical features of IBS?

Answer 17

o	Abdominal pain
o	Altered bowel habit
o	Abdominal bloating
o	Belching wind and flatus
o	Mucus

Question 18

What can be used to differentiate between IBS and IBD?

Answer 18

Calprotectin - biomarker of intestinal inflammation, seen in IBD

Question 19

What can cause IBS?

Answer 19

Altered motility
Increased visceral sensitivity
Stress