Functional Bowel Disorders

Question 1

Define functional bowel disorders

Answer 1

Persistent and recurring GI symptoms, that occur due to abnormal functioning of the GI tract

Question 2

What are the two different types of FBD and what is the difference?

Answer 2

• Structural: detectable pathology - macroscopic (i.e. cancer) or microscopic (i.e. colitis)
• Functional: no detectable pathology

Question 3

Name six different FBD

Answer 3

• Oesophageal spasm
• Non-ulcer dyspepsia
• Biliary dyskinesia
• Irritable bowel syndrome
• Slow transit constipation
• Drug related effects

Question 4

How can FBD impact psychologically?

Answer 4

QOL and cause of work absences

Question 5

What is the causative organisms of non-ulcerative dyspepsia?

Answer 5

H. pylori

Question 6

How is Non-ulcerative dyspepsia diagnosed?

Answer 6

• History (delayed gastric emptying, IBS) and examination

* H. pylori status and alarm symptoms

Question 7

What is the treatment of non-ulcerative dyspepsia?

Answer 7

Depends on H. pylori status:
• Negative -> treat symptomatically
• Positive -> eradication therapy
• In doubt -> endoscopy

Question 8

Describe the sympathetic and vagal components of vomiting and nausea

Answer 8

• Vomiting centre - induce vomiting when stimulated
• Chemoreceptor trigger zone - area of medulla that sense chemical abnormalities in the body (digoxin, chemotherapy, opiates, uraemia) and send excitatory signals to the vomiting centres

Question 9

Name five functional causes of vomiting

Answer 9

• Drugs
• Pregnancy
• Migraine
• Cyclical vomiting syndrome
• Alcohol

Question 10

What can the length of time after eating tell you about the cause of vomiting?

Answer 10

• Immediate -> psychogenic
• 1 hour or more -> pyloric obstruction or motility disorders (i.e. diabetes, post gastrectomy)
• After 12 hours -> obstruction

Question 11

What is psychogenic vomiting?

Answer 11

• Often young women and for Yeats
• No preceding nausea
• May be self-induced (overlap with bulimia)
• Appetite not usually disturbed but may los weight

Question 12

Name the alarm symptoms for FBD

Answer 12

• Over 50yrs
• Unintentional weight loss
• Nocturnal symptoms
• Male
• Family history
• Anaemia
• Rectal bleeding
• Recent antibiotic use
• Abdominal mass

Question 13

Name the investigations used for FBD

Answer 13

• FBC
• Blood gucose
• U+Es
• Thyroid status
• Coeliac serology
• FIT testing
• Calprotectin stool test
• Sigmoidoscopy
• Colonoscopy

Question 14

What can thyroid status indicate about FBD?

Answer 14

• Hyperthyroidism -> diarrhoea

* Hypothyroidism -> constipation

Question 15

What does calprotectin stool test indicate?

Answer 15

Calprotectin is a protein found on WBC, and is activated when inflammation occurs, so can identify inflammatory bowel conditions

Question 16

What are four classifications of causes of constipation?

Answer 16

• Organic
• Functional
• Systemic
• Neurogenic

Question 17

Name five organic causes of constipation

Answer 17

• Strictures
• Tumours
• Diverticular disease
• Proctitis
• Anal fissure

Question 18

Name five functional causes of constipation

Answer 18

• Megacolon
• Idiopathic constipation
• Depression
• Psychosis
• Institutionalised patients

Question 19

Name three systemic causes of constipation

Answer 19

• Diabetes mellitus
• Hypothyroidism
• Hypercalcaemia

Question 20

Name five neurogenic causes of constipation

Answer 20

• Autonomic neuropathies
• Parkinson’s disease
• Stroke
• Multiple sclerosis
• Spina bifida

Question 21

What is the presentation of irritable bowel syndrome?

Answer 21

• Abdominal pain
• Altered bowel habit
• Abdominal bloating
• Belching wind ans flatus
• Mucus

Question 22

Describe the features of abdominal pain in IBS

Answer 22

• Variable: vague, bloating, burning, sharp
• Can radiate to lower park
• Altered by bowel action

Question 23

What test can differentiate IBS and IBD?

Answer 23

Calprotectin stool test - released by inflamed gut mucosa

Question 24

What investigations do you use for IBS?

Answer 24

• Bloods: FBC, U+Es, LFTS, Ca, CRP, TFTs, Coeliac serology
• Stool culture
• Calprotectin stool test
• FIT testing

Question 25

What are the management options of IBS?

Answer 25

* Dietetic review * Drug therapy * Psychological interventions

Question 26

What is involved in the dietetic review of IBS?

Answer 26

* Lactose, gluten exclusion trial | * FODMAP diet

Question 27

What is involved in the drug therapy of IBS?

Answer 27

* Pain: antispasmodics, linaclotide * Bloating: probiotics, linaclotide (IBS-C) * Consipation: laxatives, linaclotide * Diarrhoea: anti motility agents, FODMAP

Question 28

What are different strategies in psychological interventions for IBS?

Answer 28

* Relaxation training * Hypnotherapy * Cognitive behavioural therapy * Psychogenic interpersonal therapy

Question 29

What are three different causes of IBS?

Answer 29

* Altered motility * Visceral hypersensitivity * Stress, anxiety, depression

Question 30

What is IBS-C?

Answer 30

Constipation

Question 31

What is IBS-D?

Answer 31

Diarrhoea

Question 32

What happens to muscular contractions and gut response to triggers in IBS-C and IBS-D?

Answer 32

* IBS-C - reduced | * IBS-D - stronger or more frequent