109B GI Motility disorders Flashcards Preview

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Flashcards in 109B GI Motility disorders Deck (21):
1

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

2

What the nt that leads to LES relaxation? What nerve does the signal come from?

NO
Vagus

3

what is lost that causes achalasia? what does this lead to?

idopathic enteric neuropathy leading to loss of myenteric inhibitory neurons
impaired LES relaxation

4

Achalasia Rx

drugs - nitrates, ccb (-pines), botox, PDE-5 inhibitors
pneumatic dilation
myotomy

5

sildenafil, tadalafil, vardenafil - mechanism and use

PDE-5 inhibitors --> increase cAMP --> increase NO in smooth muscle
Use for spastic motility disorders (achalsia)

6

what is a mechanical obstruction that mimics dysmotility called?

pseudo-achalasia (Cancer)

7

top 3 causes of secondary achalasia?

pseudo-achalasia (cancer)
post fundoplication (reflex surgery)
chagas disease (parasites in south america)

8

what is damaged in diabetic gastroparesis

autonomic (vagal) neuropathy from long standing DM with additional diabetic sequella

9

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

10

name 3 gastric motility disorders

diabetic gastropareiss
post surgery vagotomy
infantile hypertrophic pyloric stenosis

11

gastroparesis Rx

dietary mod (small, freq meals)
prokinetic agents (suck balls though)
Rx for 2ndary GERD

12

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)

13

scleroderma presentation

esophagus dysmotility
abdominal distension, diarrhea, weight loss
stiff hands/skin
raynauds

14

scleroderma in small bowel - appearance on xray

dilatation with stacked coin appearance

15

what general type of gi disease is scleroderma?

Intestinal pseudo-obstruction
1st is neuropathic via antibodies against muscarinic receptor
2nd is visceral myopathy leading to muscle atrohpy and fibrosis
90% esophagus, 50% small bowel

16

what diseases cause intestinal pseudo-obstruction?

post op ileus
scelroderma

17

pseudo-obstruction symptoms

abd bloating and gas
diarrhea, constipation
nausea and vomiting
weight loss

18

pseudo-obstruction manifestations?

maldigestion - poor food mixing
bacteria overrgrowth - compete for nutrients

19

pseudo-obstruction management

diet - easy digesting foods
rotating antiobiotics
avoid narcotics and ccb
no surgery

20

acute colonic pseduo-obstruction/"ogilvie syndrome" - pathology, symptoms

hindgut autonomic neural dysfunction --> impaired autonomic balance; often from surgery, trauma, sepsis
colon distension
adb pain, nausa, SOB, constipation
Rx- neostigmine, support

21

Hirschsprung;s

congenital megacolon proximal to bad segment
lack of ganglion cells due failure of neural crest migration --> cant relax
chronic constipation at birth
Rx - resection