Flashcards in EXAM #3: NON-INFECTIOUS GI MOTILITY DISORDERS Deck (31)
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1
Q
What is a primary motility disorder?
A
Motility disorder that is secondary to impaired NM control of the gut e.g. achalasia
****This is in contrast to a functional GI disorder i.e. abnormal function without structural or biochemical abnormality****
****This is in contrast to a functional GI disorder i.e. abnormal function without structural or biochemical abnormality****
2
Q
What are the signs/symptoms of primary motility disorders?
A
- Chronic N/V
- Bloating
- Abdominal pain/ discomfort
- Constipation or diarrhea
- Bloating
- Abdominal pain/ discomfort
- Constipation or diarrhea
3
Q
What causes dysmotility of the gut?
A
Disruption of the:
1) CNS
2) ANS
3) ENS
1) CNS
2) ANS
3) ENS
4
Q
List the common causes of extrinsic neuropathy leading to dysmotility.
A
1) DM
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplasic Syndrome****
****Likely to be tested
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplasic Syndrome****
****Likely to be tested
5
Q
What causes Enteric Neuropathy?
A
1) Idiopathic degeneration
2) Inflammatory/ infiltrative processes
2) Inflammatory/ infiltrative processes
6
Q
What commonly causes smooth muscle cell disease leading to dysmotility?
A
1) Metabolic muscle disorder
2) Myotonic dystrophy
2) Myotonic dystrophy
7
Q
What are the two most common causes of GI dysmotility?
A
1) Gastroparesis
2) Pseudo-obstruction
2) Pseudo-obstruction
8
Q
What are the severe manifestations of GI dysmotility?
A
- Weight loss
- Post-parandial vomiting
- Nutritional deficiency
- Dehydration and electrolyte disturbance
- Post-parandial vomiting
- Nutritional deficiency
- Dehydration and electrolyte disturbance
9
Q
What should be included in the differential diagnosis of a GI dysmotility disorder?
A
1) Mechanical obstruction
2) Crohn's Disease/ IBD
3) Autonomic neuropathy
4) Functional GI disorders
5) Eating disorders
2) Crohn's Disease/ IBD
3) Autonomic neuropathy
4) Functional GI disorders
5) Eating disorders
10
Q
What should your initial evaluation of a patient with GI dysmotility focus on?
A
1) Family history
2) Meds
3) ROS
2) Meds
3) ROS
11
Q
What is a classic PE finding associated with GI dysmotility?
A
Distention
12
Q
What may be heard when listening for bowel sounds in a patient with GI dysmotility?
A
Succussion splash
*A sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
*A sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
13
Q
How can you rule/out mechanical obstuction in a patient with an x-ray that has a bowel gas/air pattern?
A
1) EGD
2) Barium swallow
3) CT abdomen
*May do one, some, or all of these.*
2) Barium swallow
3) CT abdomen
*May do one, some, or all of these.*
14
Q
Once mechanical obstruction has been ruled out, what next?
A
Scintigraphy= patient eats radiolabeled meal and scanned at various timepoints afterward
15
Q
If dysmotility has been confirmed with Scintigraphy, what is the next step?
A
Differentiate between a neuropathic or myopathic etiology with GASTRODUODENAL MANOMEETRY
****This will measure the contraction of the GI system/ pressure generated with contraction****
****This will measure the contraction of the GI system/ pressure generated with contraction****
16
Q
How will a neuropathic problem appear on gastroduodenal manometry?
A
Abnormal contractile pattern with normal amplitude of firing
17
Q
How will a myopathic problem appear on gastroduodenal manometry?
A
Low pressure generation with contractions
18
Q
What is the definition of IBS?
A
- Abdominal pain 3x days per month for 3 months
- + 2x of the following:
1) Relieved by defecation
2) Change in stool frequency
3) Change in stool form/ appearance
- + 2x of the following:
1) Relieved by defecation
2) Change in stool frequency
3) Change in stool form/ appearance
19
Q
What are the four different subtypes of IBS?
A
IBS-D= diarrhea
IBS-C= constipation
IBS-M= mixed
IBS-A= alternating
*Note that most patients will change subtypes
IBS-C= constipation
IBS-M= mixed
IBS-A= alternating
*Note that most patients will change subtypes
20
Q
What should you focus on prior to diagnosing IBS?
A
Ruling out organic disease
21
Q
What are the red flag symptoms in the evaluation of a patient with IBS-like symptoms?
A
1) Weight loss
2) Blood in stool
3) Nocturnal diarrhea or pain
4) Steatorrhea
5) Fever, sweats, chills
2) Blood in stool
3) Nocturnal diarrhea or pain
4) Steatorrhea
5) Fever, sweats, chills
22
Q
What is "pencil thin" stool pathognmeonic for?
A
Colorectal carcinoma
23
Q
How is the abdominal pain typically described in IBS?
A
Diffuse without radiation
- LLQ
- Meal exacerbate
- Defection relief
- LLQ
- Meal exacerbate
- Defection relief
24
Q
In addition to a normal physical exam, what additional procedures should be completed>
A
1) DRE
2) Pelvic exam in female
2) Pelvic exam in female
25
Q
What labs can you order to rule out organic disorders that may mimic IBS?
A
1) Celiac antibodies
2) TSH
3) CRP/ESR for inflammation
4) Stool studies
5) Imaging
2) TSH
3) CRP/ESR for inflammation
4) Stool studies
5) Imaging
26
Q
What is the treatment approach to IBS?
A
Symptom relief
27
Q
What agents can be used to manage the pain associated with IBS?
A
1) Anti-spasmodics
2) Anti-depressants
2) Anti-depressants
28
Q
How is the constipation of IBS managed?
A
1) Fiber
2) Catharthics e.g. milk of magnesia and senna
2) Catharthics e.g. milk of magnesia and senna
29
Q
How is the diarrhea of IBS managed?
A
Loperamide
5-HT antagonist
5-HT antagonist
30
Q
What should you be sure to do when treating a patient with IBS?
A
1) Validate the patient's symptoms
2) Reassure
3) Manage to improve quality of life
2) Reassure
3) Manage to improve quality of life
31
Q
What are the mixed neural and muscle causes of dysmotility?
A
- Amyloidosis
- Mitochondrial cytopathies
- Scleroderma
- Mitochondrial cytopathies
- Scleroderma
