Functional Bowel Disorders

Question 1

Describe functional bowel disorders

Answer 1

• No detectable pathology
• Related to gut function
• Good long term prognosis

Question 2

Discuss the investigation and management of a patient with a functional bowel disorder

Answer 2

a

Question 3

Understand impact of functional bowel disorders and role of psychological factors

Answer 3

a

Question 4

Discuss alarm symptoms suggesting need for investigation

Answer 4

a

Question 5

Discuss drug, dietary and other management techniques for functional bowel disorders

Answer 5

a

Question 6

Compare and contrast pathophysiological causes of abdominal swelling and outline relevant investigations

Answer 6

a

Question 7

Describe the aetiology, presentation and management of intestinal obstruction

Answer 7

a

Question 8

Describe the presentation, investigation and treatment of non-ulcer dyspepsia.

Answer 8

Presentation: dyspeptic-like pain.

Investigation: detailed history, alarms symptoms –> endoscopy.

Treatment: if all investigations negative, treat symptomatically.

Question 9

List the functional causes of nausea and vomiting.

Answer 9

• Drugs
• Pregnancy
• Migraine
• Cyclical Vomiting Syndrome
• Alcohol

Question 10

Describe the epidemiology and presentation of psychogenic vomiting.

Answer 10

• Often younger women
• Many years, no preceding trauma
• May be self-induced (bulimia)
• Appetite not disturbed
• May be weight loss
• Often stops shortly after admission

Question 11

List the alarm symptoms for GI issues.

Answer 11

• > 50 years
• Short symptom history
• Unintentional weight loss
• Nocturnal symptoms
• Male
• Family history of GI cancer
• Anaemia
• Rectal bleeding
• Recent antibiotic use
• Abdominal mass

Question 12

List the causes of functional constipation.

Answer 12

• Megacolon
• Idiopathic
• Depression
• Psychosis

Question 13

Describe the presentation of irritable bowel syndrome (IBS).

Answer 13

• Abdominal pain: variable, can radiate, rarely at night
• Altered bowel habit
• Abdominal bloating
• Belching and flatus
• Mucus
  Occurs in a chronic relapsing, remitting pattern.

Question 14

Describe the investigation of IBS.

Answer 14

• Bloods
• Stool culture
• Calprotectin: produced in IBD, not IBS
• FIT testing

Question 15

Describe the treatment of IBS.

Answer 15

• Firm diagnosis
• Education and reassurance
• Dietetic review: lactose/gluten exclusion trial, FODMAP

Question 16

What is the appropriate investigation if a patient presents with GI symptoms and alarm symptoms?

Answer 16

Upper: endoscopy
Lower: colonoscopy

Question 17

List drugs used to treat the symptoms of functional bowel disorders.

Answer 17

Pain: antispasmodics, antidepressants.
Bloating: some probiotics.
Constipation: laxatives, 
Diarrhoea: anti-motility agents.
HOWEVER, drugs do not work well in functional disorders.

Question 18

List the psychological interventions that can be used in functional bowel disorders.

Answer 18

• Relaxation training
• Hypnotherapy
• Cognitive behavioural therapy
• Psychodynamic interpersonal therapy

Question 19

Describe how gut response is altered in IBS.

Answer 19

• Muscular contractions stronger and more frequent in IBS-D, and vice versa in IBS-C
• Triggers also stronger in IBS-D
• IBS sufferers have excessive gut awareness
• Gut is more sensitive to stress and response can become chronic