Flashcards in 109B GI Motility disorders Deck (21)
Name the 4 broad things that can cause GI motility disorders and examples
1) CNS disorder - stroke, parkinson's
2) ANS neuropathy - diabetic gastroparesis, ogilvie's syndrome
3) ENS neuropathy - Achalasia, Hirchspring's
4) Visceral myopathy - scleroderma
What the nt that leads to LES relaxation? What nerve does the signal come from?
what is lost that causes achalasia? what does this lead to?
idopathic enteric neuropathy leading to loss of myenteric inhibitory neurons
impaired LES relaxation
drugs - nitrates, ccb (-pines), botox, PDE-5 inhibitors
sildenafil, tadalafil, vardenafil - mechanism and use
PDE-5 inhibitors --> increase cAMP --> increase NO in smooth muscle
Use for spastic motility disorders (achalsia)
what is a mechanical obstruction that mimics dysmotility called?
top 3 causes of secondary achalasia?
post fundoplication (reflex surgery)
chagas disease (parasites in south america)
what is damaged in diabetic gastroparesis
autonomic (vagal) neuropathy from long standing DM with additional diabetic sequella
what motility abnormalities are seen with diabetic gastroparesis? what symptoms do these cause?
abnormal gastric accommodation --> early satiety
decreased antral contractions --> retained food
pyloric spasm --> upper abdominal pain
name 3 gastric motility disorders
post surgery vagotomy
infantile hypertrophic pyloric stenosis
dietary mod (small, freq meals)
prokinetic agents (suck balls though)
Rx for 2ndary GERD
2 general patterns for small bowel motility
fed pattern - segmentation (many focal contractions)
fasting pattern - MMC (Phase III are propagated contractions occuring every 90 minutes while fasting, pylorus opens wide)
abdominal distension, diarrhea, weight loss
scleroderma in small bowel - appearance on xray
dilatation with stacked coin appearance
what general type of gi disease is scleroderma?
1st is neuropathic via antibodies against muscarinic receptor
2nd is visceral myopathy leading to muscle atrohpy and fibrosis
90% esophagus, 50% small bowel
what diseases cause intestinal pseudo-obstruction?
post op ileus
abd bloating and gas
nausea and vomiting
maldigestion - poor food mixing
bacteria overrgrowth - compete for nutrients
diet - easy digesting foods
avoid narcotics and ccb
acute colonic pseduo-obstruction/"ogilvie syndrome" - pathology, symptoms
hindgut autonomic neural dysfunction --> impaired autonomic balance; often from surgery, trauma, sepsis
adb pain, nausa, SOB, constipation
Rx- neostigmine, support